Provider First Line Business Practice Location Address:
188 LAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARATOGA SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12866-2529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-581-9100
Provider Business Practice Location Address Fax Number:
518-581-1707
Provider Enumeration Date:
07/12/2005