Provider First Line Business Practice Location Address:
65 LONG BEACH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROOSEVELT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11575-1941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-867-2632
Provider Business Practice Location Address Fax Number:
516-378-4821
Provider Enumeration Date:
09/25/2013