Provider First Line Business Practice Location Address:
2901 216TH ST
Provider Second Line Business Practice Location Address:
ST. MARY'S HOSPITAL FOR CHILDREN
Provider Business Practice Location Address City Name:
BAYSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11360-2810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-281-8977
Provider Business Practice Location Address Fax Number:
718-281-8590
Provider Enumeration Date:
10/31/2006