Provider First Line Business Practice Location Address:
60 CENTER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLENVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-647-5300
Provider Business Practice Location Address Fax Number:
845-647-7487
Provider Enumeration Date:
10/02/2006