Provider First Line Business Practice Location Address:
144-15 JAMAICA AVENUE JAMAICA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEENS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-655-9811
Provider Business Practice Location Address Fax Number:
718-657-9799
Provider Enumeration Date:
02/08/2010