Provider First Line Business Practice Location Address:
146 NEW YORK AVE
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:
11743-2150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-549-1490
Provider Business Practice Location Address Fax Number:
631-673-7249
Provider Enumeration Date:
11/06/2006