Provider First Line Business Practice Location Address:
9002 QUEENS BLVD
Provider Second Line Business Practice Location Address:
ST. VINCENTS CATHOLIC MEDICAL CENTER
Provider Business Practice Location Address City Name:
ELMHURST
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-558-1720
Provider Business Practice Location Address Fax Number:
718-558-1783
Provider Enumeration Date:
04/09/2007