Provider First Line Business Practice Location Address:
152 E MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11743-2948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-351-1717
Provider Business Practice Location Address Fax Number:
631-351-7038
Provider Enumeration Date:
12/15/2006