Provider First Line Business Practice Location Address:
97 SOUTH PLANK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12550-3006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-561-0950
Provider Business Practice Location Address Fax Number:
845-561-8081
Provider Enumeration Date:
10/26/2005