Provider First Line Business Practice Location Address:
5519 METROPOLITAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGEWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11385-1224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-381-2245
Provider Business Practice Location Address Fax Number:
718-381-2249
Provider Enumeration Date:
12/12/2008