Provider First Line Business Practice Location Address:
327 BEACH 19TH ST
Provider Second Line Business Practice Location Address:
RADIOLOGY DEPT.
Provider Business Practice Location Address City Name:
FAR ROCKAWAY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11691-4423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-869-7710
Provider Business Practice Location Address Fax Number:
718-869-7192
Provider Enumeration Date:
08/31/2006