Provider First Line Business Practice Location Address:
880 RT 3
Provider Second Line Business Practice Location Address:
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:
518-562-0902
Provider Business Practice Location Address Fax Number:
518-566-6281
Provider Enumeration Date:
10/31/2008