Provider First Line Business Practice Location Address:
195-02 69TH AVENUE
Provider Second Line Business Practice Location Address:
P.S. 026 RUFUS KING
Provider Business Practice Location Address City Name:
QUEENS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-464-4505
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2016