Provider First Line Business Practice Location Address:
160 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATEAUGAY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-497-6110
Provider Business Practice Location Address Fax Number:
518-497-6113
Provider Enumeration Date:
07/20/2005