Provider First Line Business Practice Location Address:
25 DEGRANDPRE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12901-6449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-563-3260
Provider Business Practice Location Address Fax Number:
518-561-2877
Provider Enumeration Date:
06/27/2005