Provider First Line Business Practice Location Address:
2799 RTE 112
Provider Second Line Business Practice Location Address:
DAVIS VISION KING KALLEN SHOPPING CENTER
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-289-3939
Provider Business Practice Location Address Fax Number:
631-209-0913
Provider Enumeration Date:
05/13/2006