Provider First Line Business Practice Location Address:
1936 SARANAC AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LAKE PLACID
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12946-1114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-837-5019
Provider Business Practice Location Address Fax Number:
518-837-5093
Provider Enumeration Date:
10/27/2011