Provider First Line Business Practice Location Address:
327 BROADWAY
Provider Second Line Business Practice Location Address:
FORT EDWARD INTERNAL MEDICINE
Provider Business Practice Location Address City Name:
FORT EDWARD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12828-1233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-747-1041
Provider Business Practice Location Address Fax Number:
518-747-1022
Provider Enumeration Date:
11/07/2005