Provider First Line Business Practice Location Address:
20 W PARK AVE
Provider Second Line Business Practice Location Address:
SUITE 310B
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11561-2033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-978-1612
Provider Business Practice Location Address Fax Number:
516-374-2261
Provider Enumeration Date:
11/29/2006