Provider First Line Business Practice Location Address:
220 VETERANS HWY
Provider Second Line Business Practice Location Address:
PHOENIX HOUSE
Provider Business Practice Location Address City Name:
HAUPPAUGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-979-0922
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2010