Provider First Line Business Practice Location Address:
184 WASHINGTON AVENUE EXT.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-482-8856
Provider Business Practice Location Address Fax Number:
518-489-5839
Provider Enumeration Date:
09/03/2008