Provider First Line Business Practice Location Address:
34 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:
12946-3323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-523-2474
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/24/2010