Provider First Line Business Practice Location Address:
330 59TH ST
Provider Second Line Business Practice Location Address:
PS 503/506
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11220-3718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-492-1467
Provider Business Practice Location Address Fax Number:
718-439-4006
Provider Enumeration Date:
10/24/2006