Provider First Line Business Practice Location Address:
29-15 FAR ROCKAWAY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAR ROCKAWAY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-337-7000
Provider Business Practice Location Address Fax Number:
718-327-8897
Provider Enumeration Date:
06/15/2006