Provider First Line Business Practice Location Address:
39 51 QUEENS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-482-0003
Provider Business Practice Location Address Fax Number:
718-482-1919
Provider Enumeration Date:
12/21/2006