Provider First Line Business Practice Location Address:
920 LARK DR
Provider Second Line Business Practice Location Address:
WHITNEY M. YOUNG JR. HEALTH CENTER - MOBILE VAN
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12207-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-465-4771
Provider Business Practice Location Address Fax Number:
518-320-3022
Provider Enumeration Date:
12/17/2014