Provider First Line Business Practice Location Address:
574 SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12550-4113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-569-3911
Provider Business Practice Location Address Fax Number:
845-561-2442
Provider Enumeration Date:
02/03/2010