Provider First Line Business Practice Location Address:
210 CORNELIA ST
Provider Second Line Business Practice Location Address:
SUITE 405
Provider Business Practice Location Address City Name:
PLATTSBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12901-2318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-562-7424
Provider Business Practice Location Address Fax Number:
518-563-5076
Provider Enumeration Date:
12/14/2005