Provider First Line Business Practice Location Address:
2218 SARANAC AVE
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
LAKE PLACID
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12946-1184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-523-0090
Provider Business Practice Location Address Fax Number:
888-861-8387
Provider Enumeration Date:
04/20/2007