Individual
GRANVILLE RICHARD LEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
167 S 4TH ST, FULTON, NY 13069-1859
(315) 297-1022
Mailing address
167 S 4TH ST, FULTON, NY 13069-1859
(315) 297-1022
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
NY
Other
Enumeration date
01/05/2018
Last updated
01/05/2018
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