Provider First Line Business Practice Location Address:
211 CHURCH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARATOGO SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12866-2661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-583-8442
Provider Business Practice Location Address Fax Number:
315-295-2125
Provider Enumeration Date:
10/27/2005