Provider First Line Business Practice Location Address:
1133 ROUTE 55 STE 11
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGRANGEVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12540-5052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-477-1484
Provider Business Practice Location Address Fax Number:
845-471-2223
Provider Enumeration Date:
11/09/2005