Provider First Line Business Practice Location Address:
132 WATER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12932-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-873-3503
Provider Business Practice Location Address Fax Number:
518-873-3507
Provider Enumeration Date:
03/06/2007