Provider First Line Business Practice Location Address:
301 EAST MAIN ST
Provider Second Line Business Practice Location Address:
SOUTHSIDE HOSPITAL
Provider Business Practice Location Address City Name:
BAY SHORE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
613-968-3525
Provider Business Practice Location Address Fax Number:
631-968-3022
Provider Enumeration Date:
03/31/2007