Provider First Line Business Practice Location Address:
25-10 30TH AVE
Provider Second Line Business Practice Location Address:
MOUNT SINAI HOSPITAL OF QUEENS
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:
11102-2495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-267-4285
Provider Business Practice Location Address Fax Number:
718-278-1766
Provider Enumeration Date:
05/31/2006