Provider First Line Business Practice Location Address:
82 MIDDLE COUNTRY ROAD
Provider Second Line Business Practice Location Address:
ELSIE OWENS NORTH BROOKHAVEN HEALTH CENTER
Provider Business Practice Location Address City Name:
CORAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-854-2301
Provider Business Practice Location Address Fax Number:
631-854-2298
Provider Enumeration Date:
01/25/2007