Provider First Line Business Practice Location Address:
124 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 7
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:
631-427-1199
Provider Business Practice Location Address Fax Number:
631-944-6046
Provider Enumeration Date:
10/23/2006