Provider First Line Business Practice Location Address:
9229 QUEENS BLVD
Provider Second Line Business Practice Location Address:
SUITE # CU-6
Provider Business Practice Location Address City Name:
REGO PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11374-1056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-575-8181
Provider Business Practice Location Address Fax Number:
718-459-5118
Provider Enumeration Date:
10/03/2008