Provider First Line Business Practice Location Address:
4988 STATE HIGHWAY 30
Provider Second Line Business Practice Location Address:
ST. MARY'S HOSPITAL MEMORIAL CAMPUS
Provider Business Practice Location Address City Name:
AMSTERDAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12010-7520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-841-3481
Provider Business Practice Location Address Fax Number:
518-841-3481
Provider Enumeration Date:
02/12/2006