Provider First Line Business Practice Location Address:
596 COLUMBIA TPKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST GREENBUSH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12061-1617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-477-7373
Provider Business Practice Location Address Fax Number:
518-477-7638
Provider Enumeration Date:
10/21/2005