Provider First Line Business Practice Location Address:
239 GOLDEN HILL LANE
Provider Second Line Business Practice Location Address:
UCMH
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-340-4155
Provider Business Practice Location Address Fax Number:
845-340-4094
Provider Enumeration Date:
12/21/2006