Provider First Line Business Practice Location Address:
350 MIDDLE COUNTRY RD
Provider Second Line Business Practice Location Address:
SUITE G - LONGWOOD SPORTS THERAPY
Provider Business Practice Location Address City Name:
CORAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11727-4410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-716-2700
Provider Business Practice Location Address Fax Number:
631-716-2782
Provider Enumeration Date:
04/04/2006