Provider First Line Business Practice Location Address:
ONE HOLLOW LANE
Provider Second Line Business Practice Location Address:
SUITE 312 NORTH SHORE MEDICAL SPECIALTIES GROUP PC
Provider Business Practice Location Address City Name:
LAKE SUCCESS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-487-1414
Provider Business Practice Location Address Fax Number:
516-487-0576
Provider Enumeration Date:
03/28/2006