Provider First Line Business Practice Location Address:
92-29 QUEENS BLVD
Provider Second Line Business Practice Location Address:
SUITE CD 1ST FLOOR
Provider Business Practice Location Address City Name:
REGO PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-685-2739
Provider Business Practice Location Address Fax Number:
718-685-2375
Provider Enumeration Date:
04/09/2008