Provider First Line Business Practice Location Address:
211 SOUTH PLANK RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12550-5758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-566-4303
Provider Business Practice Location Address Fax Number:
845-566-4255
Provider Enumeration Date:
12/28/2005