Provider First Line Business Practice Location Address:
25 CLINTON ST
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:
12901-2805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-314-1126
Provider Business Practice Location Address Fax Number:
518-324-6628
Provider Enumeration Date:
10/01/2012