Provider First Line Business Practice Location Address:
2213 WANTAGH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WANTAGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11793-3917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-221-3500
Provider Business Practice Location Address Fax Number:
516-679-8012
Provider Enumeration Date:
12/17/2006