Provider First Line Business Practice Location Address:
5 CLUB RD # 2
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:
12903-3903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-324-4344
Provider Business Practice Location Address Fax Number:
518-324-4344
Provider Enumeration Date:
06/14/2006