Provider First Line Business Practice Location Address:
15-17 THIRD STREET
Provider Second Line Business Practice Location Address:
C/O INDEPENDENT LIVING CENTER OF THE HUDSON VALLEY
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-768-0667
Provider Business Practice Location Address Fax Number:
518-279-7559
Provider Enumeration Date:
12/15/2006