Provider First Line Business Practice Location Address:
55 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUPPER LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12986-2032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-359-2479
Provider Business Practice Location Address Fax Number:
518-359-8364
Provider Enumeration Date:
10/05/2020