Provider First Line Business Practice Location Address:
191 -2 90TH AVENUE
Provider Second Line Business Practice Location Address:
PS 35
Provider Business Practice Location Address City Name:
QUEENS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-465-6820
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2024