Provider First Line Business Practice Location Address:
135 S PERU ST
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:
12901-4706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-561-1321
Provider Business Practice Location Address Fax Number:
518-561-3206
Provider Enumeration Date:
01/29/2007