Provider First Line Business Practice Location Address:
RT 28
Provider Second Line Business Practice Location Address:
RT 28
Provider Business Practice Location Address City Name:
MARGARETVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-586-2631
Provider Business Practice Location Address Fax Number:
845-586-2631
Provider Enumeration Date:
10/18/2005