Provider First Line Business Practice Location Address:
94-13 FLATLANDS AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-576-1999
Provider Business Practice Location Address Fax Number:
516-593-1923
Provider Enumeration Date:
10/18/2010