Provider First Line Business Practice Location Address:
56 CENTRAL 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:
11743-2626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-643-1032
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/17/2008