Provider First Line Business Practice Location Address:
191 BRADLEY AVENUE
Provider Second Line Business Practice Location Address:
GOLDEN GATE NURSING HOME
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-698-8800
Provider Business Practice Location Address Fax Number:
718-667-9711
Provider Enumeration Date:
10/26/2009