Provider First Line Business Practice Location Address:
3227 LONG BEACH RD
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11572-3651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-897-5000
Provider Business Practice Location Address Fax Number:
516-431-7519
Provider Enumeration Date:
10/19/2006