Provider First Line Business Practice Location Address: 
3 MARKET ST
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
WAPPINGERS FALLS
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
12590-2301
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
845-321-5644
    Provider Business Practice Location Address Fax Number: 
845-632-3520
    Provider Enumeration Date: 
10/14/2015