Provider First Line Business Practice Location Address:
29-30 138TH STREET
Provider Second Line Business Practice Location Address:
APARTMENT 3F
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-715-8880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2019