Provider First Line Business Practice Location Address:
220 BROADWAY
Provider Second Line Business Practice Location Address:
TSP-NORTH AT FORT EDWARD UNION FREE SCHOOL
Provider Business Practice Location Address City Name:
FORT EDWARD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12828-1520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-746-5815
Provider Business Practice Location Address Fax Number:
518-747-2034
Provider Enumeration Date:
04/06/2010