Provider First Line Business Practice Location Address:
214 CORNELIA ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12901-2317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-561-6410
Provider Business Practice Location Address Fax Number:
518-562-7542
Provider Enumeration Date:
06/26/2008