Provider First Line Business Practice Location Address:
201 FOREST AVE
Provider Second Line Business Practice Location Address:
GLEN COVE DENTAL SERVICE PC
Provider Business Practice Location Address City Name:
GLEN COVE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-609-0800
Provider Business Practice Location Address Fax Number:
516-609-9611
Provider Enumeration Date:
02/09/2012