Provider First Line Business Practice Location Address:
203 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:
12946-1738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-824-2564
Provider Business Practice Location Address Fax Number:
833-448-3029
Provider Enumeration Date:
08/28/2023