Provider First Line Business Practice Location Address:
210 CORNELIA STREET
Provider Second Line Business Practice Location Address:
SUITE 402
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-563-7990
Provider Business Practice Location Address Fax Number:
518-563-7992
Provider Enumeration Date:
11/01/2006