Provider First Line Business Practice Location Address:
PS 224@26-RM.333-195-02-69TH AVE.
Provider Second Line Business Practice Location Address:
FRESH MEADOWS
Provider Business Practice Location Address City Name:
QUEENS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-464-4396
Provider Business Practice Location Address Fax Number:
418-264-1077
Provider Enumeration Date:
05/16/2012