Provider First Line Business Practice Location Address:
301 EAST MAIN ST.
Provider Second Line Business Practice Location Address:
NSLIJ- SOUTHSIDE HOSPITAL, DEPT. OF RADIOLOGY
Provider Business Practice Location Address City Name:
BAY SHORE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-968-3290
Provider Business Practice Location Address Fax Number:
631-968-7486
Provider Enumeration Date:
06/09/2005