Provider First Line Business Practice Location Address:
70-01 BROADWAY
Provider Second Line Business Practice Location Address:
ELMHURST HOSPITAL - H BLDG 2ND FL- H2-82;HEARING AND SP
Provider Business Practice Location Address City Name:
ELMHURST
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:
718-334-3394
Provider Business Practice Location Address Fax Number:
718-334-3909
Provider Enumeration Date:
12/16/2013