Provider First Line Business Practice Location Address:
29 SCHOOL HOUSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE SULPHYR SPRINGS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-292-5618
Provider Business Practice Location Address Fax Number:
845-794-3500
Provider Enumeration Date:
06/23/2010