Provider First Line Business Practice Location Address:
79 MIDDLEVILLE RD
Provider Second Line Business Practice Location Address:
SURGICAL SERVICES
Provider Business Practice Location Address City Name:
NORTHPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11768-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-233-2317
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2009