Provider First Line Business Practice Location Address:
11929 80TH RD
Provider Second Line Business Practice Location Address:
KEW GARDENS CENTER FOR WELLNESS SUITE 2
Provider Business Practice Location Address City Name:
KEW GARDENS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11415-1105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-424-3545
Provider Business Practice Location Address Fax Number:
718-352-0038
Provider Enumeration Date:
03/30/2008