Provider First Line Business Practice Location Address:
409 GEYSER RD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SARATOGA SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12020-3022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-583-3553
Provider Business Practice Location Address Fax Number:
515-583-4676
Provider Enumeration Date:
11/01/2006