Provider First Line Business Practice Location Address:
196 OLD MILITARY RD
Provider Second Line Business Practice Location Address:
USOC SPORTS MEDICINE
Provider Business Practice Location Address City Name:
LAKE PLACID
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12946-1940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-523-8438
Provider Business Practice Location Address Fax Number:
518-523-4808
Provider Enumeration Date:
04/12/2006