Provider First Line Business Practice Location Address:
680 COUNTY ROUTE 18
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CLEAR
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12945-1813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-891-4367
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2012