Provider First Line Business Practice Location Address:
1785 MILITARY TPKE
Provider Second Line Business Practice Location Address:
SUITE 14
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12901-7704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-562-2009
Provider Business Practice Location Address Fax Number:
518-562-2119
Provider Enumeration Date:
12/11/2006