Provider First Line Business Practice Location Address:
2140 SARANAC AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE PLACID
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12946-1149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-697-7595
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2011