Provider First Line Business Practice Location Address:
ROUTE 22
Provider Second Line Business Practice Location Address:
PALEN PAVILION
Provider Business Practice Location Address City Name:
MARGARETVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-339-8700
Provider Business Practice Location Address Fax Number:
914-593-7881
Provider Enumeration Date:
03/28/2006