Provider First Line Business Practice Location Address:
959 STATE ROUTE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEENSBURY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12804-6250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-792-8747
Provider Business Practice Location Address Fax Number:
518-792-6612
Provider Enumeration Date:
12/19/2012