Provider First Line Business Practice Location Address:
82-70 164TH STREET
Provider Second Line Business Practice Location Address:
C/O EMERGENCY DEPARTMENT
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-883-3000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2008