Provider First Line Business Practice Location Address:
7513 COURT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12932-0008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-873-3670
Provider Business Practice Location Address Fax Number:
518-873-3777
Provider Enumeration Date:
08/18/2006