Provider First Line Business Practice Location Address:
434 S KINGSBORO AVE STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12095-3822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-773-4242
Provider Business Practice Location Address Fax Number:
518-773-4246
Provider Enumeration Date:
08/28/2016