Provider First Line Business Practice Location Address:
49 LAWRENCE AVUENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTSDAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-261-5550
Provider Business Practice Location Address Fax Number:
315-261-5598
Provider Enumeration Date:
01/07/2008