Provider First Line Business Practice Location Address:
216 HENRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEMPSTEAD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11550-6333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-485-8774
Provider Business Practice Location Address Fax Number:
516-481-6855
Provider Enumeration Date:
05/03/2007