Provider First Line Business Practice Location Address:
461 CLINTON ST EXT STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHENECTADY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12305-2425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-374-7222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2005