Provider First Line Business Practice Location Address:
1556 STRAIGHT PATH
Provider Second Line Business Practice Location Address:
MARTIN LUTHER KING JR HEALTH CENTER
Provider Business Practice Location Address City Name:
WYANDANCH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-854-1781
Provider Business Practice Location Address Fax Number:
631-854-1783
Provider Enumeration Date:
10/11/2006