Provider First Line Business Practice Location Address:
36-36 33RD STREET
Provider Second Line Business Practice Location Address:
SUITE 500 THERAPETIC RESOURCES
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-589-1224
Provider Business Practice Location Address Fax Number:
646-218-3756
Provider Enumeration Date:
05/02/2011