Provider First Line Business Practice Location Address:
52 TOM MILLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12901-1252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-324-4000
Provider Business Practice Location Address Fax Number:
518-324-4001
Provider Enumeration Date:
08/15/2006