Provider First Line Business Practice Location Address:
25- 10 30TH AVENUE
Provider Second Line Business Practice Location Address:
MOUNT SINAI HOSPITAL OF QUEENS
Provider Business Practice Location Address City Name:
LONG ISLAND CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-932-1000
Provider Business Practice Location Address Fax Number:
718-906-6201
Provider Enumeration Date:
06/15/2007