Provider First Line Business Practice Location Address:
1044 WESTERN AVENUE
Provider Second Line Business Practice Location Address:
EAGLE POINT ELEMENTARY
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12203-2714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-475-6830
Provider Business Practice Location Address Fax Number:
518-475-6829
Provider Enumeration Date:
12/12/2011