Provider First Line Business Practice Location Address:
48 AMHERST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE GEORGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12845-1219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-668-4024
Provider Business Practice Location Address Fax Number:
518-668-2140
Provider Enumeration Date:
11/02/2005