Provider First Line Business Practice Location Address:
6012 COUNTY FARM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALLSTON SPA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12020-2251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-584-7460
Provider Business Practice Location Address Fax Number:
518-682-5619
Provider Enumeration Date:
04/02/2025