Provider First Line Business Practice Location Address:
THE FORTUNE SOCIETY INC.
Provider Second Line Business Practice Location Address:
29-76 NORTHERN BLVD 2ND FL
Provider Business Practice Location Address City Name:
LONG ISLAND CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11101-2822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-691-7554
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2020