Provider First Line Business Practice Location Address:
104 FULTON AVE
Provider Second Line Business Practice Location Address:
CHILD MED GRP
Provider Business Practice Location Address City Name:
POUGHKEEPSIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12603-2808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-981-0912
Provider Business Practice Location Address Fax Number:
845-765-2489
Provider Enumeration Date:
11/19/2010