Provider First Line Business Practice Location Address:
4164 NY ROUTE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROPSEYVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-788-4567
Provider Business Practice Location Address Fax Number:
518-272-3911
Provider Enumeration Date:
10/24/2006