Provider First Line Business Practice Location Address:
10 ST PATRICK PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT HENRY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12974-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-546-7151
Provider Business Practice Location Address Fax Number:
518-546-3785
Provider Enumeration Date:
12/10/2010