Provider First Line Business Practice Location Address:
138-15 FRANKLIN AVE
Provider Second Line Business Practice Location Address:
(401)
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11355
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-207-5523
Provider Business Practice Location Address Fax Number:
718-358-4553
Provider Enumeration Date:
12/30/2008