Provider First Line Business Practice Location Address:
129 MAIN ST
Provider Second Line Business Practice Location Address:
APT 6
Provider Business Practice Location Address City Name:
SARANAC LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12983-1756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-637-7582
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2012