Provider First Line Business Practice Location Address:
141 WASHINGTON AVENUE EXT STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12205-5610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-464-1803
Provider Business Practice Location Address Fax Number:
518-464-0076
Provider Enumeration Date:
09/27/2024