Provider First Line Business Practice Location Address:
1202 TROY-SCHENECTADY RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LATHAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-374-8001
Provider Business Practice Location Address Fax Number:
518-374-5923
Provider Enumeration Date:
09/16/2006