Provider First Line Business Practice Location Address:
32-50 VERNON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEENS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-267-5516
Provider Business Practice Location Address Fax Number:
718-267-3693
Provider Enumeration Date:
08/14/2012