Provider First Line Business Practice Location Address:
27 NORTH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-334-2390
Provider Business Practice Location Address Fax Number:
845-343-5390
Provider Enumeration Date:
02/09/2007