Provider First Line Business Practice Location Address: 
7 CHAPIN LN
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
PAWLING
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
12564-3337
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
845-278-9670
    Provider Business Practice Location Address Fax Number: 
914-593-7881
    Provider Enumeration Date: 
11/16/2010