Provider First Line Business Practice Location Address:
2128 ROCKAWAY PARKWAY
Provider Second Line Business Practice Location Address:
INSTITUTE FOR COMMUNITY LIVING, INC.
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-418-4556
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2010