Provider First Line Business Practice Location Address:
289 DANIEL STREET
Provider Second Line Business Practice Location Address:
DANIEL STREET ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
LINDENHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11757-3502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-867-3300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2007