Provider First Line Business Practice Location Address:
120 HIGHLAND AVE
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:
10940-4713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-342-1033
Provider Business Practice Location Address Fax Number:
845-344-5631
Provider Enumeration Date:
07/14/2009