Provider First Line Business Practice Location Address:
17 WEST MERRICK ROAD
Provider Second Line Business Practice Location Address:
SUITE A DENTAL ASSOCIATES OF VALLEY STREAM DC
Provider Business Practice Location Address City Name:
VALLEY STREAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11580-5718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-825-6695
Provider Business Practice Location Address Fax Number:
516-825-6642
Provider Enumeration Date:
02/21/2007