Provider First Line Business Practice Location Address:
349 NEW YORK AVE
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:
11743-3342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-427-2919
Provider Business Practice Location Address Fax Number:
631-427-2909
Provider Enumeration Date:
02/20/2013