Individual
MR. CHARLES EVAN WATTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SERVICE PROVIDER
Contact information
Practice address
1069 MAIN STREET, CHAMPLAIN, NY 12919-5444
(518) 298-3512
Mailing address
1069 MAIN STREET, CHAMPLAIN, NY 12919-5444
(518) 298-3512
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
819628063
NY
Other
Enumeration date
07/24/2013
Last updated
07/24/2013
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