Provider First Line Business Practice Location Address:
96 E MAIN 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:
11743-2816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-351-4840
Provider Business Practice Location Address Fax Number:
631-351-5756
Provider Enumeration Date:
06/30/2009