Provider First Line Business Practice Location Address:
196 E MAIN ST
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:
11743-2922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-271-8030
Provider Business Practice Location Address Fax Number:
631-271-8448
Provider Enumeration Date:
09/22/2006