Provider First Line Business Practice Location Address:
95 CRYSTAL RUN RD
Provider Second Line Business Practice Location Address:
CRYSTAL RUN HEALTHCARE
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10941-7001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-703-6999
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2006