Provider First Line Business Practice Location Address:
3080 21ST ST
Provider Second Line Business Practice Location Address:
2ND FLOOR MEDICAL CENTER
Provider Business Practice Location Address City Name:
ASTORIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11102-4242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-873-9550
Provider Business Practice Location Address Fax Number:
718-228-4591
Provider Enumeration Date:
07/20/2011