Provider First Line Business Practice Location Address:
6025 NYS RTE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALATINE BRIDGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-673-2366
Provider Business Practice Location Address Fax Number:
518-673-2387
Provider Enumeration Date:
08/16/2006