Provider First Line Business Practice Location Address:
762 STATE ROUTE 3
Provider Second Line Business Practice Location Address:
STE 15
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12901-7472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-907-0225
Provider Business Practice Location Address Fax Number:
518-561-5335
Provider Enumeration Date:
04/12/2007