Provider First Line Business Practice Location Address:
789 EAST MAIN 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:
10940-0270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-343-0787
Provider Business Practice Location Address Fax Number:
845-343-2644
Provider Enumeration Date:
01/16/2007