Provider First Line Business Practice Location Address:
22 N SERVICE RD BLDG 22A
Provider Second Line Business Practice Location Address:
JFK INT'L AIRPORT
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11430-1618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-244-1644
Provider Business Practice Location Address Fax Number:
718-244-1622
Provider Enumeration Date:
12/13/2006