Provider First Line Business Practice Location Address:
158 EAST MAIN ST
Provider Second Line Business Practice Location Address:
STE 7
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-271-4180
Provider Business Practice Location Address Fax Number:
631-271-4184
Provider Enumeration Date:
08/15/2006