Provider First Line Business Practice Location Address:
118 OHIO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11561-1130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-431-3211
Provider Business Practice Location Address Fax Number:
516-431-4211
Provider Enumeration Date:
04/18/2007