Provider First Line Business Practice Location Address:
1127 DALEWOOD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGSTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12401-1011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-336-5114
Provider Business Practice Location Address Fax Number:
845-336-7590
Provider Enumeration Date:
12/27/2005