Provider First Line Business Practice Location Address:
1 EDGEWATER ST
Provider Second Line Business Practice Location Address:
1ST FL. LAB
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10305-4900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-226-4130
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/30/2008