Provider First Line Business Practice Location Address:
220 08 HEMPSTED AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEENS VILLAGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-776-2300
Provider Business Practice Location Address Fax Number:
718-776-2800
Provider Enumeration Date:
05/20/2006