Provider First Line Business Practice Location Address:
38-15 149TH STREET
Provider Second Line Business Practice Location Address:
#2S
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11354-6302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-492-1843
Provider Business Practice Location Address Fax Number:
718-888-9650
Provider Enumeration Date:
07/16/2012