Provider First Line Business Practice Location Address:
91 LAKES RD
Provider Second Line Business Practice Location Address:
MED ARTS BLDG
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10950-2613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-782-8608
Provider Business Practice Location Address Fax Number:
845-782-8516
Provider Enumeration Date:
07/29/2005