Provider First Line Business Practice Location Address:
1133 STATE ROUTE 55 STE F
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:
12540-5057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-682-3677
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/14/2026