Provider First Line Business Practice Location Address:
1472 DEKALB AVE
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:
11237-3604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-381-0018
Provider Business Practice Location Address Fax Number:
718-456-4983
Provider Enumeration Date:
12/26/2006