Provider First Line Business Practice Location Address:
1996 SARANAC AVE
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:
12946-1140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-524-1141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/07/2017