Provider First Line Business Practice Location Address:
6825 STATE ROUTE 22
Provider Second Line Business Practice Location Address:
APT 1
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12901-4915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-578-7385
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2010