Provider First Line Business Practice Location Address:
25 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARANAC LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12983-1816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-891-5611
Provider Business Practice Location Address Fax Number:
518-891-2055
Provider Enumeration Date:
05/23/2005