Provider First Line Business Practice Location Address:
63 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:
11743-2159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-385-0207
Provider Business Practice Location Address Fax Number:
631-385-1272
Provider Enumeration Date:
05/25/2006