Provider First Line Business Practice Location Address:
56-31 141ST STREET
Provider Second Line Business Practice Location Address:
ORAL PATHOLOGY LABORATORY INC
Provider Business Practice Location Address City Name:
FLUSHING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11355-5016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-670-1520
Provider Business Practice Location Address Fax Number:
718-445-4147
Provider Enumeration Date:
10/06/2006