Provider First Line Business Practice Location Address:
2 PRO HEALTH PLZ
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11042-1111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-390-5760
Provider Business Practice Location Address Fax Number:
516-390-5765
Provider Enumeration Date:
05/17/2011