Please use the following form to get more information on membership in the
Enterprise.
Number of Employees:
Contact:
Title:
Company Name:
Business Address:
City:
State:
ZIP/Postal Code:
Telephone:
Fax:
E-Mail Address:
THANK YOU!
        
You may submit by clicking above or you can print and fill out the form
and fax it to (631) 297-3060 or send it to:

    LIA Enterprise Membership
    Enrollment Processing Center
    1717 Veterans Memorial Highway, Suite 4
    Islandia, NY 11749

    If you have any questions, please call 1-800-431-1290

 
LIA Health Alliance Website 2007