Provider First Line Business Practice Location Address:
231 WADE ROAD EXT
Provider Second Line Business Practice Location Address:
SUITE 101
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:
518-782-1900
Provider Business Practice Location Address Fax Number:
518-782-1318
Provider Enumeration Date:
08/06/2009