Provider First Line Business Practice Location Address:
1100 DIXON AVENUE
Provider Second Line Business Practice Location Address:
COPIAGUE HIGH SCHOOL
Provider Business Practice Location Address City Name:
COPIAGUE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-842-4010
Provider Business Practice Location Address Fax Number:
631-842-4018
Provider Enumeration Date:
07/10/2012