Provider First Line Business Practice Location Address:
175 EAST MAIN STREET
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:
11743-3399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-424-3787
Provider Business Practice Location Address Fax Number:
631-427-0198
Provider Enumeration Date:
09/28/2006