Provider First Line Business Practice Location Address:
762 STATE ROUTE 3
Provider Second Line Business Practice Location Address:
SUITE 1
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:
518-324-2273
Provider Business Practice Location Address Fax Number:
518-324-2276
Provider Enumeration Date:
10/26/2006