Provider First Line Business Practice Location Address:
3178 NOSTRAND AVE
Provider Second Line Business Practice Location Address:
LB
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-998-1669
Provider Business Practice Location Address Fax Number:
718-998-2969
Provider Enumeration Date:
10/26/2006