Provider First Line Business Practice Location Address:
2237A WANTAGH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WANTAGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11793-3917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-826-0116
Provider Business Practice Location Address Fax Number:
516-826-0115
Provider Enumeration Date:
06/21/2005