Provider First Line Business Practice Location Address:
15 DEGRANDPRE WAY
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:
12901-6449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-561-3900
Provider Business Practice Location Address Fax Number:
518-561-7843
Provider Enumeration Date:
08/16/2005