Provider First Line Business Practice Location Address:
152-11 89 AVE
Provider Second Line Business Practice Location Address:
MARY IMMACULATE HOSPITAL
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-558-2000
Provider Business Practice Location Address Fax Number:
718-558-2022
Provider Enumeration Date:
06/06/2007