Provider First Line Business Practice Location Address:
142 BOYNTON AVE
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:
12901-1292
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-879-5151
Provider Business Practice Location Address Fax Number:
866-561-8426
Provider Enumeration Date:
08/14/2013