Provider First Line Business Practice Location Address:
201 MANOR PL
Provider Second Line Business Practice Location Address:
EASTERN LONG ISLAND HOSPITAL
Provider Business Practice Location Address City Name:
GREENPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11944-1222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-548-6146
Provider Business Practice Location Address Fax Number:
631-548-6150
Provider Enumeration Date:
04/11/2007