Provider First Line Business Practice Location Address:
50 SPENCE AVENUE
Provider Second Line Business Practice Location Address:
TAMARAC ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
HOLTSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11742-1929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-244-5680
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2011