Provider First Line Business Practice Location Address:
31 S 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:
12550-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-565-2140
Provider Business Practice Location Address Fax Number:
845-565-2229
Provider Enumeration Date:
09/18/2012