Provider First Line Business Practice Location Address:
75 WASHINGTON 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-565-0777
Provider Business Practice Location Address Fax Number:
516-486-6305
Provider Enumeration Date:
08/15/2012