Provider First Line Business Practice Location Address:
95 CLINTON ST
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:
11550-4211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-967-0397
Provider Business Practice Location Address Fax Number:
516-569-2788
Provider Enumeration Date:
01/18/2017