Provider First Line Business Practice Location Address:
16 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARANAC LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12983-1802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-891-1205
Provider Business Practice Location Address Fax Number:
518-891-0413
Provider Enumeration Date:
05/17/2007