Provider First Line Business Practice Location Address:
624 MCCLELLAN ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SCHENECTADY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12304-1088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-377-6429
Provider Business Practice Location Address Fax Number:
518-377-1291
Provider Enumeration Date:
09/12/2006