Provider First Line Business Practice Location Address:
434 DEKALB AVE
Provider Second Line Business Practice Location Address:
LAFAYETTE CHC
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11205-4406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-638-8258
Provider Business Practice Location Address Fax Number:
718-783-6524
Provider Enumeration Date:
07/11/2006