Provider First Line Business Practice Location Address:
16 STATE ROUTE 9P
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALLSTON SPA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12020-4287
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-584-6320
Provider Business Practice Location Address Fax Number:
518-584-8800
Provider Enumeration Date:
12/31/2008