Provider First Line Business Practice Location Address:
256 MASON AVENUE, BLDG B
Provider Second Line Business Practice Location Address:
UNITED MEDICAL SURGICAL, PC
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-226-1300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2006