Provider First Line Business Practice Location Address:
2445 STATE ROUTE 30
Provider Second Line Business Practice Location Address:
PHARMACY
Provider Business Practice Location Address City Name:
TUPPER LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12986-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-359-4247
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2014