Provider First Line Business Practice Location Address:
206 CORNELIA ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12901-2779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-314-3340
Provider Business Practice Location Address Fax Number:
518-314-3468
Provider Enumeration Date:
10/10/2006