Provider First Line Business Practice Location Address:
820 ROUTE 9
Provider Second Line Business Practice Location Address:
SUITE #1308
Provider Business Practice Location Address City Name:
QUEENSBURY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12804-1749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-745-1200
Provider Business Practice Location Address Fax Number:
518-745-8441
Provider Enumeration Date:
04/25/2006