Provider First Line Business Practice Location Address:
2580 INGLEWOOD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST MEADOW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11554-5309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-369-0381
Provider Business Practice Location Address Fax Number:
516-369-0381
Provider Enumeration Date:
07/30/2012