Provider First Line Business Practice Location Address:
21 N 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:
12550-2128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-565-5943
Provider Business Practice Location Address Fax Number:
845-234-4556
Provider Enumeration Date:
09/25/2006