Provider First Line Business Practice Location Address: 
900 DUTCHESS TPKE
    Provider Second Line Business Practice Location Address: 
DUTCHESS BOCES ALTERNATIVE HIGH SCHOOL
    Provider Business Practice Location Address City Name: 
POUGHKEEPSIE
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
12603-1554
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
845-486-4840
    Provider Business Practice Location Address Fax Number: 
845-486-4852
    Provider Enumeration Date: 
10/04/2011