Provider First Line Business Practice Location Address:
2412 34TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG ISLAND CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11106-4320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-383-3882
Provider Business Practice Location Address Fax Number:
718-383-3886
Provider Enumeration Date:
10/30/2006