Provider First Line Business Practice Location Address:
63 HURLEY AVE
Provider Second Line Business Practice Location Address:
KINGSTON VA PRIMARY CARE CENTER
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12401-2832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-331-8322
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2005