Provider First Line Business Practice Location Address:
1145 ROUTE 55 STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGRANGEVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12540-5047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-473-6620
Provider Business Practice Location Address Fax Number:
845-473-5116
Provider Enumeration Date:
11/03/2006