Provider First Line Business Practice Location Address:
199 SCHOOLHOUSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STUYVESANT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12173-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-758-2738
Provider Business Practice Location Address Fax Number:
518-325-4111
Provider Enumeration Date:
04/23/2007