Provider First Line Business Practice Location Address:
12 INTERSTATE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLONIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12205-5319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-452-7795
Provider Business Practice Location Address Fax Number:
518-452-4494
Provider Enumeration Date:
10/20/2010