Provider First Line Business Practice Location Address:
2 PRO HEALTH PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE SUCCESS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11042-1111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-622-6116
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2006