Provider First Line Business Practice Location Address:
76 E MAIN ST
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11743-2837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-424-1170
Provider Business Practice Location Address Fax Number:
631-424-1171
Provider Enumeration Date:
08/07/2006