Provider First Line Business Practice Location Address:
SAMARITAN DAYTOP VILLAGE 138-02 QUEENS BOULEVARD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIARWOOD
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:
845-647-6575
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2018