Provider First Line Business Practice Location Address:
400 STATE ROUTE 17M
Provider Second Line Business Practice Location Address:
SUITE 10A
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10950-4415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-782-9191
Provider Business Practice Location Address Fax Number:
845-782-1222
Provider Enumeration Date:
08/24/2007