Provider First Line Business Practice Location Address:
86 MAIN ST
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:
12983-5736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-891-5189
Provider Business Practice Location Address Fax Number:
518-891-1992
Provider Enumeration Date:
04/26/2007