Provider First Line Business Practice Location Address:
39-16 PRINCE STREET
Provider Second Line Business Practice Location Address:
UNIT 355
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-886-6882
Provider Business Practice Location Address Fax Number:
718-886-7883
Provider Enumeration Date:
06/25/2008