Provider First Line Business Practice Location Address:
10704 ROCKAWAY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OZONE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11417-2310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-678-3130
Provider Business Practice Location Address Fax Number:
718-323-2110
Provider Enumeration Date:
03/02/2026