Provider First Line Business Practice Location Address: 
1900 HEMPSTEAD TPKE
    Provider Second Line Business Practice Location Address: 
SUITE 500
    Provider Business Practice Location Address City Name: 
EAST MEADOW
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
11554-1724
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
516-542-1090
    Provider Business Practice Location Address Fax Number: 
516-794-8165
    Provider Enumeration Date: 
10/14/2005