Provider First Line Business Practice Location Address:
102 PARK STREET PRUYN PAVILION - LOWER LEVEL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENS FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12801-4403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-793-5601
Provider Business Practice Location Address Fax Number:
518-793-5916
Provider Enumeration Date:
09/20/2006