Provider First Line Business Practice Location Address:
242 E BROADWAY
Provider Second Line Business Practice Location Address:
6
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11561-4209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-241-2793
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2011