Provider First Line Business Practice Location Address:
ATLANTIC TERMINAL MALL
Provider Second Line Business Practice Location Address:
139 FLATBUSH AVENUE
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-622-6100
Provider Business Practice Location Address Fax Number:
718-622-7637
Provider Enumeration Date:
05/17/2007