Provider First Line Business Practice Location Address:
5572 ROUTE 11
Provider Second Line Business Practice Location Address:
NORTHERN ADIRONDACK CENTRAL SCHOOL
Provider Business Practice Location Address City Name:
ELLENBURG DEPOT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-594-3986
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/22/2010