Provider First Line Business Practice Location Address: 
2215 BURDETT AVENUE
    Provider Second Line Business Practice Location Address: 
SAMARITAN BEHAVIORAL HEALTH
    Provider Business Practice Location Address City Name: 
TROY
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
12180-2466
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
518-833-6470
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
08/25/2019