Provider First Line Business Practice Location Address:
20-02 SEAGIRT BLVD
Provider Second Line Business Practice Location Address:
JBFCS TRANSITION CENTER
Provider Business Practice Location Address City Name:
FAR ROCKAWAY, QUEENS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-520-8045
Provider Business Practice Location Address Fax Number:
718-327-4230
Provider Enumeration Date:
10/16/2006