Provider First Line Business Practice Location Address:
35- 24 83RD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON HEIGHTS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-639-0070
Provider Business Practice Location Address Fax Number:
718-639-7684
Provider Enumeration Date:
10/10/2011