Provider First Line Business Practice Location Address: 
26 SAW MILL CT
    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: 
12866-5696
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
518-573-1554
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
11/13/2014