Provider First Line Business Practice Location Address:
93 20 LIBERTY AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OZONE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-641-5648
Provider Business Practice Location Address Fax Number:
718-835-2064
Provider Enumeration Date:
10/19/2006