Provider First Line Business Practice Location Address:
82-68 164TH STREET
Provider Second Line Business Practice Location Address:
QUEENS HOSPITAL CENTER
Provider Business Practice Location Address City Name:
QUEENS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11432-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-883-4050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2008