Provider First Line Business Practice Location Address:
1785 MILITARY TPKE
Provider Second Line Business Practice Location Address:
SUITE # 12
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:
518-561-5700
Provider Business Practice Location Address Fax Number:
518-561-5700
Provider Enumeration Date:
12/12/2006