Provider First Line Business Practice Location Address:
1401 UNION STREET
Provider Second Line Business Practice Location Address:
PSYCHOLOGY SUITE
Provider Business Practice Location Address City Name:
SCHENECTADY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12308-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-381-4105
Provider Business Practice Location Address Fax Number:
518-381-4096
Provider Enumeration Date:
09/25/2006