Provider First Line Business Practice Location Address:
13 PALMER AVE
Provider Second Line Business Practice Location Address:
EVERGREEN HEALTH CENTER
Provider Business Practice Location Address City Name:
CORINTH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12822-1145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-654-6499
Provider Business Practice Location Address Fax Number:
518-654-7303
Provider Enumeration Date:
07/30/2006