Provider First Line Business Practice Location Address:
1065 BAKER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHENECTADY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12309-5701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-881-3548
Provider Business Practice Location Address Fax Number:
518-881-3542
Provider Enumeration Date:
12/23/2011