Provider First Line Business Practice Location Address:
9716 ROCKAWAY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OZONE PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-848-2040
Provider Business Practice Location Address Fax Number:
718-848-2026
Provider Enumeration Date:
12/06/2023