Provider First Line Business Practice Location Address:
66 PARK STREET
Provider Second Line Business Practice Location Address:
ELIZABETHTROWN HEALTH CENTER
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12932-0277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-895-4050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/19/2013