Provider First Line Business Practice Location Address:
2071 CLOVE RD
Provider Second Line Business Practice Location Address:
GRASMERE MEDICAL PAVILLION
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10304-1671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-442-5550
Provider Business Practice Location Address Fax Number:
718-556-3025
Provider Enumeration Date:
03/21/2007