Provider First Line Business Practice Location Address:
1 PRO HEALTH PLZ
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-467-8191
Provider Business Practice Location Address Fax Number:
516-467-8192
Provider Enumeration Date:
10/07/2015