Provider First Line Business Practice Location Address:
260 NORTH STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-565-5054
Provider Business Practice Location Address Fax Number:
845-565-4071
Provider Enumeration Date:
11/11/2010