Provider First Line Business Practice Location Address:
1471 DEKALB AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11237-3894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-452-3469
Provider Business Practice Location Address Fax Number:
718-452-3459
Provider Enumeration Date:
04/12/2013