Provider First Line Business Practice Location Address:
656 N. WELLWOOD AVE
Provider Second Line Business Practice Location Address:
LOUIS LASKY MEMORIAL MEDICAL & DENTAL CENTER
Provider Business Practice Location Address City Name:
LINDENHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-225-1010
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/15/2010