Provider First Line Business Practice Location Address:
380 NASSAU RD
Provider Second Line Business Practice Location Address:
LONG ISLAND FQHC, INC.
Provider Business Practice Location Address City Name:
ROOSEVELT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11575-1343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-571-8600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2006