Provider First Line Business Practice Location Address:
22 NORTH PARK STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-677-7882
Provider Business Practice Location Address Fax Number:
518-677-5392
Provider Enumeration Date:
08/22/2006