Provider First Line Business Practice Location Address:
66-87 FRESH POND ROAD
Provider Second Line Business Practice Location Address:
MIL-RUE CHEMISTS, INC.
Provider Business Practice Location Address City Name:
RIDGEWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11385-3948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-821-3271
Provider Business Practice Location Address Fax Number:
718-386-9777
Provider Enumeration Date:
02/10/2010