Provider First Line Business Practice Location Address:
30 BRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT HENRY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12974-1441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-570-5520
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2008