Provider First Line Business Practice Location Address:
141 JERUSALEM AVE
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:
11550-6331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-538-4760
Provider Business Practice Location Address Fax Number:
516-538-8333
Provider Enumeration Date:
11/21/2005