Provider First Line Business Practice Location Address:
1024 49TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG ISLAND CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11101-5613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-786-1104
Provider Business Practice Location Address Fax Number:
718-391-0040
Provider Enumeration Date:
02/14/2011