Provider First Line Business Practice Location Address:
380 GUY PARK AVE
Provider Second Line Business Practice Location Address:
ST. MARY'S HOSPITAL, FAM HLTH CNTR AT CARONDELET PAVILI
Provider Business Practice Location Address City Name:
AMSTERDAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-841-7415
Provider Business Practice Location Address Fax Number:
518-841-7422
Provider Enumeration Date:
07/18/2005