Provider First Line Business Practice Location Address:
13714 233RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11422-1726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-881-2488
Provider Business Practice Location Address Fax Number:
646-881-2488
Provider Enumeration Date:
01/02/2026