Provider First Line Business Practice Location Address:
295 NEW YORK RD
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:
12903-4425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-562-8200
Provider Business Practice Location Address Fax Number:
518-562-7188
Provider Enumeration Date:
03/10/2009