Provider First Line Business Practice Location Address:
2626 75TH STREET
Provider Second Line Business Practice Location Address:
LEXINGTON CENTER FOR MH CENTER
Provider Business Practice Location Address City Name:
EAST ELMHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-350-3158
Provider Business Practice Location Address Fax Number:
718-350-3067
Provider Enumeration Date:
12/19/2014