Provider First Line Business Practice Location Address:
1228 WANTAGH AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
WANTAGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11793-2209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-826-1666
Provider Business Practice Location Address Fax Number:
516-783-7716
Provider Enumeration Date:
01/11/2006