Provider First Line Business Practice Location Address:
19 DEWITT ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10940
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-342-4081
Provider Business Practice Location Address Fax Number:
888-801-4331
Provider Enumeration Date:
11/28/2006