Provider First Line Business Practice Location Address:
2 BRIDGE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARGARETVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12455-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-586-2955
Provider Business Practice Location Address Fax Number:
845-586-1388
Provider Enumeration Date:
01/24/2008