Provider First Line Business Practice Location Address:
819 ORIENTAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-3026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-646-3524
Provider Business Practice Location Address Fax Number:
718-646-5178
Provider Enumeration Date:
08/15/2005