Provider First Line Business Practice Location Address:
29 CHURCH 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:
12946-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-523-1327
Provider Business Practice Location Address Fax Number:
518-523-9964
Provider Enumeration Date:
07/19/2005