Provider First Line Business Practice Location Address:
ONE WEST AVENUE
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
SARATOGA SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-587-0499
Provider Business Practice Location Address Fax Number:
518-587-0536
Provider Enumeration Date:
07/24/2006