Provider First Line Business Practice Location Address:
42-09 28TH STREET
Provider Second Line Business Practice Location Address:
CN 22A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-396-2656
Provider Business Practice Location Address Fax Number:
347-396-2753
Provider Enumeration Date:
12/14/2012