Provider First Line Business Practice Location Address:
118 MERILINA AVE
Provider Second Line Business Practice Location Address:
J WATSON BAILEY MIDDLE SCHOOL
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12401-4226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-943-3940
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2025