Provider First Line Business Practice Location Address:
259 1ST ST
Provider Second Line Business Practice Location Address:
ATTN: DEPT OF RADIOLOGY
Provider Business Practice Location Address City Name:
MINEOLA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11501-3957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-663-2501
Provider Business Practice Location Address Fax Number:
516-663-8558
Provider Enumeration Date:
04/05/2006