Provider First Line Business Practice Location Address:
47- 07 30 PL.
Provider Second Line Business Practice Location Address:
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:
11101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-472-5671
Provider Business Practice Location Address Fax Number:
718-472-9117
Provider Enumeration Date:
03/28/2012