Provider First Line Business Practice Location Address:
2421 LONG BEACH RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11572-1361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-992-2282
Provider Business Practice Location Address Fax Number:
516-415-7604
Provider Enumeration Date:
05/22/2006