Provider First Line Business Practice Location Address:
2355 ROUTE 145
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST DURHAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12423-1620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-634-2494
Provider Business Practice Location Address Fax Number:
518-634-2494
Provider Enumeration Date:
03/28/2007