Provider First Line Business Practice Location Address:
123 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:
11217-1237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-834-9884
Provider Business Practice Location Address Fax Number:
718-834-9567
Provider Enumeration Date:
01/29/2007