Provider First Line Business Practice Location Address:
30 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:
11201-5314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-744-7209
Provider Business Practice Location Address Fax Number:
718-488-1919
Provider Enumeration Date:
04/30/2008