Provider First Line Business Practice Location Address: 
131 LAWRENCE ST
    Provider Second Line Business Practice Location Address: 
OUTPATIENT THERAPIES
    Provider Business Practice Location Address City Name: 
SARATOGA SPRINGS
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
12866-1346
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
518-691-1454
    Provider Business Practice Location Address Fax Number: 
518-691-1460
    Provider Enumeration Date: 
08/16/2006