Provider First Line Business Practice Location Address:
2507 SOUTH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POUGHKEEPSIE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12601-5465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-471-3112
Provider Business Practice Location Address Fax Number:
845-471-3115
Provider Enumeration Date:
12/23/2005