Provider First Line Business Practice Location Address:
NORTHERN BLVD
Provider Second Line Business Practice Location Address:
ACADEMIC HEALTH CARE CENTER, NY INSTITUTE OF TECHNOLOGY
Provider Business Practice Location Address City Name:
OLD WESTBURY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11568-8000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-686-1300
Provider Business Practice Location Address Fax Number:
516-686-7890
Provider Enumeration Date:
10/31/2005