Provider First Line Business Practice Location Address:
124 MAIN ST
Provider Second Line Business Practice Location Address:
STE 9
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-271-7136
Provider Business Practice Location Address Fax Number:
631-271-0533
Provider Enumeration Date:
10/02/2006