Provider First Line Business Practice Location Address:
160 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
ANESTHESIA DEPT
Provider Business Practice Location Address City Name:
PORT JERVIS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12771-2253
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-357-5775
Provider Business Practice Location Address Fax Number:
845-357-5777
Provider Enumeration Date:
08/18/2005