Provider First Line Business Practice Location Address:
73 CENTER STREET
Provider Second Line Business Practice Location Address:
73 CENTER STREET - PO BOX 222
Provider Business Practice Location Address City Name:
ELLENVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-647-8677
Provider Business Practice Location Address Fax Number:
845-647-4984
Provider Enumeration Date:
07/24/2017