Provider First Line Business Practice Location Address:
1100 ELM AVE
Provider Second Line Business Practice Location Address:
C/O PS 199
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11230-5847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-339-1422
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2009