Provider First Line Business Practice Location Address:
309 COUNTY ROUTE 47
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SARANAC LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12983-5405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-891-2688
Provider Business Practice Location Address Fax Number:
518-891-4120
Provider Enumeration Date:
08/02/2005