Provider First Line Business Practice Location Address:
52 ELM ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11743-3489
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-424-8818
Provider Business Practice Location Address Fax Number:
631-424-8819
Provider Enumeration Date:
08/31/2006