Provider First Line Business Practice Location Address:
24 GARDNER AVE
Provider Second Line Business Practice Location Address:
MIDDLETOWN HIGH SCHOOL
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10940-3240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-326-1259
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2007