Provider First Line Business Practice Location Address:
1100 WANTAGH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WANTAGH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11793-2130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-308-4633
Provider Business Practice Location Address Fax Number:
516-308-3378
Provider Enumeration Date:
12/20/2013