Provider First Line Business Practice Location Address:
1157 ROUTE 55 ROOM 2114
Provider Second Line Business Practice Location Address:
ARLINGTON H.S.
Provider Business Practice Location Address City Name:
LAGRANGEVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-486-4860
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/18/2011