Provider First Line Business Practice Location Address:
8931 161ST ST
Provider Second Line Business Practice Location Address:
DET MEDICAL P.C.
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11432-6102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-526-1839
Provider Business Practice Location Address Fax Number:
718-526-6169
Provider Enumeration Date:
07/26/2006