Provider First Line Business Practice Location Address:
145 COMMUNITY DRIVE
Provider Second Line Business Practice Location Address:
NORTH SHORE-LIJ HEALTH SYSTEM
Provider Business Practice Location Address City Name:
GREAT NECK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-465-3194
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2007