Provider First Line Business Practice Location Address:
33 GRAND ST
Provider Second Line Business Practice Location Address:
GRAND STREET GASTROENTEROLOGY
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12401-3933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-338-2300
Provider Business Practice Location Address Fax Number:
845-338-9711
Provider Enumeration Date:
08/16/2012