Provider First Line Business Practice Location Address:
1 ELM STREET PARKWAY PLAZA MEDICAL CENTER
Provider Second Line Business Practice Location Address:
SUITE 2B
Provider Business Practice Location Address City Name:
TUCKAHOE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-337-9100
Provider Business Practice Location Address Fax Number:
914-337-9485
Provider Enumeration Date:
12/12/2006