Provider First Line Business Practice Location Address:
2108 LINDEN 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:
11207-7411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-498-9898
Provider Business Practice Location Address Fax Number:
718-317-1892
Provider Enumeration Date:
08/23/2005