Provider First Line Business Practice Location Address:
5645 MAIN ST
Provider Second Line Business Practice Location Address:
NEW YORK HOSPITAL OF QUEENS, DEPARTMENT OF PEDIATRICS.
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11355-5045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-670-1033
Provider Business Practice Location Address Fax Number:
718-240-6602
Provider Enumeration Date:
07/14/2006