Provider First Line Business Practice Location Address:
46 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-237-0641
Provider Business Practice Location Address Fax Number:
518-235-6401
Provider Enumeration Date:
10/12/2006