Provider First Line Business Practice Location Address:
142 LAUREL PARK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALLSBURG
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12733-5009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-436-1850
Provider Business Practice Location Address Fax Number:
845-436-1851
Provider Enumeration Date:
05/21/2008