Provider First Line Business Practice Location Address:
1220 WASHINGTON AVE BLDG 30
Provider Second Line Business Practice Location Address:
NYSP FIC
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12226-1799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-457-8678
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2006