Provider First Line Business Practice Location Address:
396 TOM MILLER RD
Provider Second Line Business Practice Location Address:
UNIT B
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12901-6430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
151-832-4554
Provider Business Practice Location Address Fax Number:
206-984-3043
Provider Enumeration Date:
01/18/2007