Provider First Line Business Practice Location Address:
19 DEWITT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10940-3913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-551-6075
Provider Business Practice Location Address Fax Number:
845-344-5699
Provider Enumeration Date:
04/03/2007