Provider First Line Business Practice Location Address:
90 FEEDER DAM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH GLENS FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12803-5419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-744-9829
Provider Business Practice Location Address Fax Number:
518-792-8075
Provider Enumeration Date:
12/17/2007