Provider First Line Business Practice Location Address:
694 BEACH 20TH STREET FLR 3
Provider Second Line Business Practice Location Address:
CARE COORDINATION NHCC
Provider Business Practice Location Address City Name:
FAR ROCKAWAY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11691-3502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-634-3445
Provider Business Practice Location Address Fax Number:
718-412-1129
Provider Enumeration Date:
04/27/2020