Provider First Line Business Practice Location Address:
4161 ROUTE 22
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:
12901-5883
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-563-0040
Provider Business Practice Location Address Fax Number:
518-562-0632
Provider Enumeration Date:
06/28/2006