Provider First Line Business Practice Location Address:
401 DITMAS AVE
Provider Second Line Business Practice Location Address:
MEDICAL DENTAL PLAZA
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-972-1644
Provider Business Practice Location Address Fax Number:
718-871-6368
Provider Enumeration Date:
11/27/2006