Provider First Line Business Practice Location Address:
153-23 83 STREET
Provider Second Line Business Practice Location Address:
PS 232 Q
Provider Business Practice Location Address City Name:
HOWARD BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-848-9247
Provider Business Practice Location Address Fax Number:
718-738-8505
Provider Enumeration Date:
03/27/2012