Provider First Line Business Practice Location Address:
350 NATIONAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 2C
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11561-3327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-432-0545
Provider Business Practice Location Address Fax Number:
516-432-0597
Provider Enumeration Date:
10/25/2006