Provider First Line Business Practice Location Address:
8808 ROCKAWAY BEACH BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKAWAY BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11693-1608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-634-8922
Provider Business Practice Location Address Fax Number:
718-634-5740
Provider Enumeration Date:
03/29/2010