Provider First Line Business Practice Location Address:
761 FRANKLIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11561-2450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-897-2692
Provider Business Practice Location Address Fax Number:
516-897-0941
Provider Enumeration Date:
07/18/2006