Provider First Line Business Practice Location Address:
20 RIDGE 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:
10940-3305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-343-2500
Provider Business Practice Location Address Fax Number:
845-343-1077
Provider Enumeration Date:
10/06/2006