Provider First Line Business Practice Location Address:
387 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROOSEVELT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11575-1849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-377-2067
Provider Business Practice Location Address Fax Number:
516-377-2119
Provider Enumeration Date:
02/01/2007