Provider First Line Business Practice Location Address:
3051 LONG BEACH RD
Provider Second Line Business Practice Location Address:
SUITE #3
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-766-4875
Provider Business Practice Location Address Fax Number:
516-766-0569
Provider Enumeration Date:
11/03/2008