Provider First Line Business Practice Location Address:
215 WASHINGTON AVENUE EXT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12205-5534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-452-0914
Provider Business Practice Location Address Fax Number:
518-452-5953
Provider Enumeration Date:
10/21/2005