Provider First Line Business Practice Location Address:
418 ST MARK'S PLACE
Provider Second Line Business Practice Location Address:
ST MARK'S DENTAL
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-720-6836
Provider Business Practice Location Address Fax Number:
718-720-6996
Provider Enumeration Date:
08/08/2006