Provider First Line Business Practice Location Address:
140 BEACH 114STREET
Provider Second Line Business Practice Location Address:
PROMENADEN URSING HOME
Provider Business Practice Location Address City Name:
ROCKAWAY PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11694
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-353-3209
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2015