Provider First Line Business Practice Location Address:
23 SOUTH PERRY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12095-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-736-1500
Provider Business Practice Location Address Fax Number:
518-762-8194
Provider Enumeration Date:
11/15/2006