Provider First Line Business Practice Location Address:
55 LEBKAMP 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:
11743-5509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-355-9488
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2026