Provider First Line Business Practice Location Address:
1415 E. THIRD AVE.
Provider Second Line Business Practice Location Address:
MARY G CLARKSOP ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
BAY SHORE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11706-4221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-968-1205
Provider Business Practice Location Address Fax Number:
631-968-2461
Provider Enumeration Date:
03/29/2012