Provider First Line Business Practice Location Address:
5094 ROUTE 22
Provider Second Line Business Practice Location Address:
BOX 48
Provider Business Practice Location Address City Name:
AMENIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-373-8000
Provider Business Practice Location Address Fax Number:
845-373-8236
Provider Enumeration Date:
04/30/2008