Provider First Line Business Practice Location Address:
22202 HEMPSTEAD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUEENS VILLAGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-217-6200
Provider Business Practice Location Address Fax Number:
718-217-4191
Provider Enumeration Date:
02/14/2007