Provider First Line Business Practice Location Address:
6 WELLNESS WAY STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LATHAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12110-2156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-782-7733
Provider Business Practice Location Address Fax Number:
518-782-0800
Provider Enumeration Date:
09/15/2011