Provider First Line Business Practice Location Address:
270-05 76TH AVE
Provider Second Line Business Practice Location Address:
ATTN: VIVO HEALTH PHARMACY AT LIJ
Provider Business Practice Location Address City Name:
NEW HYDE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11040-1402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-470-8486
Provider Business Practice Location Address Fax Number:
718-470-5508
Provider Enumeration Date:
10/01/2014