Provider First Line Business Practice Location Address:
42-00 72ND STREET
Provider Second Line Business Practice Location Address:
NYC DEPARTMENT OF EDUCATION- P.S. 12
Provider Business Practice Location Address City Name:
WOODSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11377
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-395-9134
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/30/2013