Provider First Line Business Practice Location Address:
2623 STATE HIGHWAY 30A
Provider Second Line Business Practice Location Address:
VA PRIMARY CARE PRACTICE, FONDA
Provider Business Practice Location Address City Name:
FONDA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12068-5961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-853-1247
Provider Business Practice Location Address Fax Number:
518-853-1250
Provider Enumeration Date:
10/26/2006