Provider First Line Business Practice Location Address:
71 PROSPECT AVENUE
Provider Second Line Business Practice Location Address:
DENTAL PROGRAM
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-669-7892
Provider Business Practice Location Address Fax Number:
518-669-7893
Provider Enumeration Date:
11/24/2009