Provider First Line Business Practice Location Address:
FORT HAMILTON ARMY BASE
Provider Second Line Business Practice Location Address:
BLDG #114 RM 1-19
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11252-6530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-630-4915
Provider Business Practice Location Address Fax Number:
718-630-4941
Provider Enumeration Date:
10/31/2005