Provider First Line Business Practice Location Address:
96-05 QUEENS BLVD
Provider Second Line Business Practice Location Address:
SEARS MIRACLE EAR
Provider Business Practice Location Address City Name:
REGO PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-275-5954
Provider Business Practice Location Address Fax Number:
718-275-5964
Provider Enumeration Date:
05/19/2010