Provider First Line Business Practice Location Address:
47-4 48 AVENUE
Provider Second Line Business Practice Location Address:
3S
Provider Business Practice Location Address City Name:
LONG ISLAND CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-986-5622
Provider Business Practice Location Address Fax Number:
212-423-6326
Provider Enumeration Date:
11/22/2006