Provider First Line Business Practice Location Address:
8928 MERRICK BLVD
Provider Second Line Business Practice Location Address:
100 WASHINGTON ST. HEMPSTEAD NY 11550
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11432-5243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-291-9456
Provider Business Practice Location Address Fax Number:
718-558-0861
Provider Enumeration Date:
10/21/2005