Provider First Line Business Practice Location Address:
536 BAY RD
Provider Second Line Business Practice Location Address:
SUITE1
Provider Business Practice Location Address City Name:
QUEENSBURY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12804-1425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-793-2483
Provider Business Practice Location Address Fax Number:
518-793-2485
Provider Enumeration Date:
01/12/2007