Provider First Line Business Practice Location Address:
2 CENTRE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST ROCKAWAY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11518-1110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-825-0952
Provider Business Practice Location Address Fax Number:
213-832-1216
Provider Enumeration Date:
01/01/2026