Provider First Line Business Practice Location Address:
1228 WANTAGH AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
WANTAGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11793-2209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-679-7978
Provider Business Practice Location Address Fax Number:
516-826-5830
Provider Enumeration Date:
08/08/2006