Provider First Line Business Practice Location Address:
401 LINCOLN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-633-2236
Provider Business Practice Location Address Fax Number:
718-848-7273
Provider Enumeration Date:
03/06/2012