Provider First Line Business Practice Location Address:
2249 STATE ROUTE 86
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
SARANAC LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12983-5644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-891-3845
Provider Business Practice Location Address Fax Number:
518-891-1236
Provider Enumeration Date:
02/14/2006