Provider First Line Business Practice Location Address:
90 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARANAC LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12983-5735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-891-0104
Provider Business Practice Location Address Fax Number:
518-891-7130
Provider Enumeration Date:
05/14/2007