Provider First Line Business Practice Location Address:
424 LEONARD ST
Provider Second Line Business Practice Location Address:
JHS 126
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-782-2527
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2007