Provider First Line Business Practice Location Address:
279 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW PALTZ
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-255-3046
Provider Business Practice Location Address Fax Number:
914-593-7881
Provider Enumeration Date:
02/07/2006