Provider First Line Business Practice Location Address:
116 WASHINGTON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11561-3032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-208-9917
Provider Business Practice Location Address Fax Number:
516-208-9917
Provider Enumeration Date:
06/26/2006