Provider First Line Business Practice Location Address:
1219 COUNTY ROUTE 13
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLD CHATHAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12136-2712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-794-9400
Provider Business Practice Location Address Fax Number:
518-766-5471
Provider Enumeration Date:
10/17/2006