Provider First Line Business Practice Location Address:
100 CALIFORNIA AVENUE
Provider Second Line Business Practice Location Address:
ROESSLEVILLE ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12205-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-459-2157
Provider Business Practice Location Address Fax Number:
518-459-0268
Provider Enumeration Date:
11/22/2011