Provider First Line Business Practice Location Address:
241 E MAIN 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:
11743-2917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-812-2873
Provider Business Practice Location Address Fax Number:
917-979-4997
Provider Enumeration Date:
02/17/2006