Provider First Line Business Practice Location Address:
29 ENGLEWOOD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST GREENBUSH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12061-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-477-2756
Provider Business Practice Location Address Fax Number:
518-477-8124
Provider Enumeration Date:
12/26/2006