Provider First Line Business Practice Location Address:
ROUTE 208, BOX G
Provider Second Line Business Practice Location Address:
WALLKIL CORRECTIONAL FACILITY DENTAL DEPT.
Provider Business Practice Location Address City Name:
WALLKILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12589-0286
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-895-2021
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2006