Provider First Line Business Practice Location Address:
210 S FRANKLIN 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:
11550-5613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-483-1767
Provider Business Practice Location Address Fax Number:
516-481-4905
Provider Enumeration Date:
07/30/2006