Provider First Line Business Practice Location Address:
55 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12095-2633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-736-1100
Provider Business Practice Location Address Fax Number:
518-736-1101
Provider Enumeration Date:
06/05/2006