Provider First Line Business Practice Location Address:
39-11 104TH STREET
Provider Second Line Business Practice Location Address:
A FAIR DEAL PHARMACY, INC.
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11368-2313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-478-3908
Provider Business Practice Location Address Fax Number:
718-478-3908
Provider Enumeration Date:
02/05/2010