Provider First Line Business Practice Location Address:
685 SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12550-4117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-534-0066
Provider Business Practice Location Address Fax Number:
845-784-1594
Provider Enumeration Date:
07/23/2007