Provider First Line Business Practice Location Address:
185 OLD MILITARY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE PLACID
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12946-1939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-523-5612
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/26/2012