Provider First Line Business Practice Location Address:
1 DOROTHEA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVIEW
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11803-6211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-932-1616
Provider Business Practice Location Address Fax Number:
516-932-1632
Provider Enumeration Date:
07/25/2007