Provider First Line Business Practice Location Address:
146 MEADOWLAWN 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:
11743-2763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-456-9945
Provider Business Practice Location Address Fax Number:
631-470-3289
Provider Enumeration Date:
12/18/2008