Provider First Line Business Practice Location Address:
25 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT PLAIN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13339-1365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-993-4000
Provider Business Practice Location Address Fax Number:
518-993-4501
Provider Enumeration Date:
10/17/2011