Provider First Line Business Practice Location Address:
34 N PLANK RD STE S-2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12550-2137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-419-0528
Provider Business Practice Location Address Fax Number:
845-236-3695
Provider Enumeration Date:
10/22/2008