Provider First Line Business Practice Location Address:
91 HAMMOND LANE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-562-5600
Provider Business Practice Location Address Fax Number:
518-562-9211
Provider Enumeration Date:
11/06/2006