Provider First Line Business Practice Location Address:
1 PLAINFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELMONT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11003-1263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-326-7772
Provider Business Practice Location Address Fax Number:
516-326-2749
Provider Enumeration Date:
04/14/2010