Provider First Line Business Practice Location Address:
32 S WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEENSBURY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12804-3323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-743-1557
Provider Business Practice Location Address Fax Number:
518-743-1557
Provider Enumeration Date:
12/18/2006