Provider First Line Business Practice Location Address:
239 LAKESIDE RD
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12550-5758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-566-4303
Provider Business Practice Location Address Fax Number:
845-566-4255
Provider Enumeration Date:
04/14/2006