Provider First Line Business Practice Location Address:
2038 SARANAC AVE
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:
12946-1177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-588-5173
Provider Business Practice Location Address Fax Number:
845-205-4454
Provider Enumeration Date:
08/13/2012