Provider First Line Business Practice Location Address:
1301 RIVER ST RM 101
Provider Second Line Business Practice Location Address:
VALATIE MEDICAL ARTS BLDG
Provider Business Practice Location Address City Name:
VALATIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12184-9696
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-758-6101
Provider Business Practice Location Address Fax Number:
518-758-2162
Provider Enumeration Date:
07/08/2005