Provider First Line Business Practice Location Address:
1696 WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEAFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11783-1903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-781-3115
Provider Business Practice Location Address Fax Number:
516-781-3119
Provider Enumeration Date:
05/18/2010