Provider First Line Business Practice Location Address:
164 BOYNTON AVENUE
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-324-7920
Provider Business Practice Location Address Fax Number:
518-324-7922
Provider Enumeration Date:
12/04/2006