Provider First Line Business Practice Location Address:
62 SCHOOL ST
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:
12946-3325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-963-5700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2021