Provider First Line Business Practice Location Address:
1116 HIGHBRIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHENECTADY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12303-2528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-249-1818
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2005