Provider First Line Business Practice Location Address:
99 EAST STATE STREET
Provider Second Line Business Practice Location Address:
MAB 101
Provider Business Practice Location Address City Name:
GLOVERSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12078-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-773-5246
Provider Business Practice Location Address Fax Number:
518-773-5252
Provider Enumeration Date:
07/28/2006