189 FOREST AVENUE, GLEN COVE, 11542, NEW YORK
| Entity Name | KEVIN T. CUSTIS, M.D., P.C. |
| Entity Number | 2369196 |
| Status | ACTIVE |
| Incorporation Date | 20th April 1999 |
| Dos Process Address | 828 WILLOUGHBY AVE, BROOKLYN, 11206, NEW YORK |
| Jurisdiction | NEW YORK |
| County | KINGS |
| Legal form | DOMESTIC PROFESSIONAL CORPORATION |