Provider First Line Business Practice Location Address:
1726 CAMPBELL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHENECTADY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12306-5014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-372-5370
Provider Business Practice Location Address Fax Number:
518-372-3472
Provider Enumeration Date:
08/21/2007