Provider First Line Business Practice Location Address:
8561 NEWCOMB RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12847-0129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-624-2301
Provider Business Practice Location Address Fax Number:
518-624-2043
Provider Enumeration Date:
07/28/2006