Provider First Line Business Practice Location Address:
4870 HYLAN BOULEVARD
Provider Second Line Business Practice Location Address:
SOUTH SHORE SI PHYSICAL THERAPY
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-227-0198
Provider Business Practice Location Address Fax Number:
718-948-0772
Provider Enumeration Date:
07/28/2008