Provider First Line Business Practice Location Address:
12 ACADEMY 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:
12983-1941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-323-6644
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/22/2011