Provider First Line Business Practice Location Address:
1367 BROADWAY
Provider Second Line Business Practice Location Address:
SAMS DRUGS BROOKLYN
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-453-6866
Provider Business Practice Location Address Fax Number:
718-452-2686
Provider Enumeration Date:
08/31/2006