Provider First Line Business Practice Location Address:
34 NORTH PLANK ROAD
Provider Second Line Business Practice Location Address:
SUITE R-2
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-562-0168
Provider Business Practice Location Address Fax Number:
845-562-0169
Provider Enumeration Date:
04/29/2009