Provider First Line Business Practice Location Address:
2120 HEMPSTEAD TPKE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
EAST MEADOW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11554-1849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-496-7791
Provider Business Practice Location Address Fax Number:
516-665-8079
Provider Enumeration Date:
01/19/2012