Provider First Line Business Practice Location Address:
3435 12TH ST # A
Provider Second Line Business Practice Location Address:
RAVENSWOOD SENIOR CENTER
Provider Business Practice Location Address City Name:
LONG ISLAND CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11106-5057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-609-1028
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2007