Provider First Line Business Practice Location Address:
25 LAFAYETTE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCHENECTADY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12305-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-393-6535
Provider Business Practice Location Address Fax Number:
518-374-6375
Provider Enumeration Date:
08/03/2010