Provider First Line Business Practice Location Address:
266 NORTH STREET
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
NEWBURGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-565-5437
Provider Business Practice Location Address Fax Number:
845-565-7021
Provider Enumeration Date:
08/16/2006