Provider First Line Business Practice Location Address:
127 MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GUILDERLAND CENTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-861-5141
Provider Business Practice Location Address Fax Number:
518-861-6529
Provider Enumeration Date:
09/16/2005