Provider First Line Business Practice Location Address:
127 E MAIN ST
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:
10940-5118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-248-6311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2005