Provider First Line Business Practice Location Address:
121 LAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARATOGA SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12866-2420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-587-8225
Provider Business Practice Location Address Fax Number:
518-587-8244
Provider Enumeration Date:
05/19/2006