Provider First Line Business Practice Location Address:
1 EDGEWATER PLAZA
Provider Second Line Business Practice Location Address:
1ST FL. LAB
Provider Business Practice Location Address City Name:
STATEN ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10305-4900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-226-4130
Provider Business Practice Location Address Fax Number:
718-226-4185
Provider Enumeration Date:
03/08/2006