Provider First Line Business Practice Location Address:
11 HAMMOND LN STE C
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:
12901-2003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-562-0054
Provider Business Practice Location Address Fax Number:
518-563-5518
Provider Enumeration Date:
02/24/2007