Provider First Line Business Practice Location Address:
NURSE PRACTITIONER
Provider Second Line Business Practice Location Address:
YELLOW PRIMARY CARE CLINIC, VAMC, 76 MIDDLEVILLE ROAD
Provider Business Practice Location Address City Name:
NORTHPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-261-4400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2005