Provider First Line Business Practice Location Address:
2 ALBERT ST
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:
10940-3902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-342-5411
Provider Business Practice Location Address Fax Number:
845-342-3252
Provider Enumeration Date:
01/29/2011