Provider First Line Business Practice Location Address:
2284 SARANAC AVE
Provider Second Line Business Practice Location Address:
SUITE 3B
Provider Business Practice Location Address City Name:
LAKE PLACID
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12946-3558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-837-5222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/26/2009