Provider First Line Business Practice Location Address:
218 S. CENTRAL AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MECHANICVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-664-1188
Provider Business Practice Location Address Fax Number:
518-664-1187
Provider Enumeration Date:
03/01/2007