Provider First Line Business Practice Location Address:
201 ROOSEVELT 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:
11561-3713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-849-5411
Provider Business Practice Location Address Fax Number:
516-432-6647
Provider Enumeration Date:
02/18/2020