Provider First Line Business Practice Location Address:
65 ORIENTAL BLVD
Provider Second Line Business Practice Location Address:
LBB
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-4945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-769-6777
Provider Business Practice Location Address Fax Number:
718-769-6775
Provider Enumeration Date:
04/25/2007