Provider First Line Business Practice Location Address:
5 HEMPHILL PL
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:
12020-4422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-289-5072
Provider Business Practice Location Address Fax Number:
518-289-5225
Provider Enumeration Date:
09/21/2010