Provider First Line Business Practice Location Address:
1670 E 17TH ST # 78
Provider Second Line Business Practice Location Address:
INTERBOROUGH DEVELOPMENTAL AND CONSULTATION CENTER
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-1258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-502-0762
Provider Business Practice Location Address Fax Number:
718-245-2517
Provider Enumeration Date:
09/14/2006