Provider First Line Business Practice Location Address:
358 TOM MILLER ROAD
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:
12901-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-561-8465
Provider Business Practice Location Address Fax Number:
518-561-3182
Provider Enumeration Date:
06/11/2006