Provider First Line Business Practice Location Address:
13525 243RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11422-1642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-262-4087
Provider Business Practice Location Address Fax Number:
516-210-2096
Provider Enumeration Date:
01/06/2026