Provider First Line Business Practice Location Address:
23 HIGH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-794-5558
Provider Business Practice Location Address Fax Number:
845-794-0135
Provider Enumeration Date:
08/02/2006