Provider First Line Business Practice Location Address:
1201 NOTT ST
Provider Second Line Business Practice Location Address:
MEDICAL ARTS BLDG STE 306
Provider Business Practice Location Address City Name:
SCHENECTADY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12308-2589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-377-6080
Provider Business Practice Location Address Fax Number:
518-377-9490
Provider Enumeration Date:
05/05/2006