Provider First Line Business Practice Location Address:
451 EAST MAIN 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:
845-343-7529
Provider Business Practice Location Address Fax Number:
845-343-7532
Provider Enumeration Date:
06/15/2007