Provider First Line Business Practice Location Address:
198 NEW YORK AVE
Provider Second Line Business Practice Location Address:
STORE #1
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11743-2746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-470-9670
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/22/2006