Provider First Line Business Practice Location Address:
582 NEW LOUDON RD
Provider Second Line Business Practice Location Address:
ST PETER'S INTERNAL MEDICINE
Provider Business Practice Location Address City Name:
LATHAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12110-5709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-783-0072
Provider Business Practice Location Address Fax Number:
518-783-8138
Provider Enumeration Date:
12/07/2012