Provider First Line Business Practice Location Address:
231 DEKALB AVE
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:
11205-4101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-638-4350
Provider Business Practice Location Address Fax Number:
718-622-4960
Provider Enumeration Date:
05/18/2006