Provider First Line Business Practice Location Address:
34-33 JUNCTION BLVD
Provider Second Line Business Practice Location Address:
CORONA CHEST CENTER FL2
Provider Business Practice Location Address City Name:
JACKSON HEIGHTS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11372-3828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-396-5134
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/18/2008