Provider First Line Business Practice Location Address:
462 MAPLE 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-581-8888
Provider Business Practice Location Address Fax Number:
518-583-4185
Provider Enumeration Date:
10/02/2006