Provider First Line Business Practice Location Address:
16 BALTIMORE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12903-4205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-563-7371
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/15/2007