Provider First Line Business Practice Location Address:
25 LAKEHILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALLSTON LAKE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12019-2429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-399-9141
Provider Business Practice Location Address Fax Number:
518-399-0343
Provider Enumeration Date:
11/17/2011