Provider First Line Business Practice Location Address:
332 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:
11205-3820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-852-5252
Provider Business Practice Location Address Fax Number:
718-802-1113
Provider Enumeration Date:
03/13/2007