Provider First Line Business Practice Location Address:
1 WEBSTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12428-1109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-647-8181
Provider Business Practice Location Address Fax Number:
845-647-3947
Provider Enumeration Date:
10/10/2005