Provider First Line Business Practice Location Address:
25302 ROCKAWAY BLVD STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSEDALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11422-3114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-949-4040
Provider Business Practice Location Address Fax Number:
212-949-9700
Provider Enumeration Date:
10/17/2022