Provider First Line Business Practice Location Address:
382 NEW YORK AVENUE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-421-1771
Provider Business Practice Location Address Fax Number:
631-421-9861
Provider Enumeration Date:
03/29/2006