Provider First Line Business Practice Location Address: 
1101 NOTT ST
    Provider Second Line Business Practice Location Address: 
DEPARTMENT OF EMERGENCY
    Provider Business Practice Location Address City Name: 
SCHENECTADY
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
12308-2425
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
518-243-4121
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
07/02/2006