Provider First Line Business Practice Location Address:
290 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARATOGA SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-581-0278
Provider Business Practice Location Address Fax Number:
518-581-9633
Provider Enumeration Date:
11/20/2006