Provider First Line Business Practice Location Address:
PROFESSIONAL PLAZA 233 7TH ST.
Provider Second Line Business Practice Location Address:
2FL SUITE
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11530-4147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-662-8258
Provider Business Practice Location Address Fax Number:
516-385-2913
Provider Enumeration Date:
07/10/2006