Provider First Line Business Practice Location Address:
1448 ROUTE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH GLENS FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-761-6961
Provider Business Practice Location Address Fax Number:
518-761-1006
Provider Enumeration Date:
07/18/2006