Provider First Line Business Practice Location Address:
2233 STATE ROUTE 86
Provider Second Line Business Practice Location Address:
LAKE COLBY DRIVE
Provider Business Practice Location Address City Name:
SARANAC LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12983-5644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-897-2264
Provider Business Practice Location Address Fax Number:
518-897-2260
Provider Enumeration Date:
11/08/2006