Provider First Line Business Practice Location Address:
205 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 1-2
Provider Business Practice Location Address City Name:
HUNTINGTON
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11743-2923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-592-7218
Provider Business Practice Location Address Fax Number:
631-239-5821
Provider Enumeration Date:
11/07/2006