Provider First Line Business Practice Location Address:
164 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11743-2955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-385-2020
Provider Business Practice Location Address Fax Number:
631-385-5688
Provider Enumeration Date:
01/05/2007