Provider First Line Business Practice Location Address:
2215 SARANAC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE PLACID
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12946-1152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-598-3131
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2026