Provider First Line Business Practice Location Address:
158 SARATOGA AVE.
Provider Second Line Business Practice Location Address:
WATERFORD HEALTH CENTER
Provider Business Practice Location Address City Name:
WATERFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-233-1162
Provider Business Practice Location Address Fax Number:
518-233-0903
Provider Enumeration Date:
11/16/2006