Provider First Line Business Practice Location Address:
88 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARANAC LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12983-1860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-891-0680
Provider Business Practice Location Address Fax Number:
518-891-0683
Provider Enumeration Date:
12/16/2005