Provider First Line Business Practice Location Address:
30 S OCEAN AVE
Provider Second Line Business Practice Location Address:
C/O MINTZ & SCHAFFER
Provider Business Practice Location Address City Name:
FREEPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11520-3550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-607-0910
Provider Business Practice Location Address Fax Number:
516-623-4299
Provider Enumeration Date:
01/15/2011