Provider First Line Business Practice Location Address:
3 LANTERN 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:
11743-4741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-864-9139
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2008