Provider First Line Business Practice Location Address:
511 7TH AVE
Provider Second Line Business Practice Location Address:
ROOM 261 PS 10, LUTHERAN MEDICAL CENTER
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11215-6126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-788-6572
Provider Business Practice Location Address Fax Number:
718-788-6624
Provider Enumeration Date:
02/26/2007