Provider First Line Business Practice Location Address:
79-01 BROADWAY, D6-04, ELMHURST HOSPITAL CENTER, DEPT O
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-334-4000
Provider Business Practice Location Address Fax Number:
718-334-4904
Provider Enumeration Date:
05/31/2022