Provider First Line Business Practice Location Address:
327 BEACH 19TH ST
Provider Second Line Business Practice Location Address:
DEPT. OF MEDICINE
Provider Business Practice Location Address City Name:
FAR ROCKAWAY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11691-4423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-998-6037
Provider Business Practice Location Address Fax Number:
718-869-8530
Provider Enumeration Date:
08/05/2007