Provider First Line Business Practice Location Address:
30 PRESCOTT PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARANAC LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12983-1829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-891-6140
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/11/2007