Provider First Line Business Practice Location Address:
176 LAKE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARATOGA SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12866-2529
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-935-0068
Provider Business Practice Location Address Fax Number:
518-581-1145
Provider Enumeration Date:
11/03/2010