Provider First Line Business Practice Location Address:
556 49TH AVE
Provider Second Line Business Practice Location Address:
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:
11101-5611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-784-4178
Provider Business Practice Location Address Fax Number:
718-784-4757
Provider Enumeration Date:
07/13/2006