Provider First Line Business Practice Location Address:
188-03 JAMAICA AVENUE
Provider Second Line Business Practice Location Address:
JHMC-DTC
Provider Business Practice Location Address City Name:
HOLLIS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-740-2060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/06/2006