Provider First Line Business Practice Location Address:
61 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:
10940-5534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-665-9975
Provider Business Practice Location Address Fax Number:
845-544-2896
Provider Enumeration Date:
10/20/2006