Provider First Line Business Practice Location Address:
205 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 2-8
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:
631-424-1741
Provider Business Practice Location Address Fax Number:
631-424-1745
Provider Enumeration Date:
02/03/2006