Provider First Line Business Practice Location Address: 
35 101ST AVE
    Provider Second Line Business Practice Location Address: 
AN-NOOR PHARMACY INC.
    Provider Business Practice Location Address City Name: 
BROOKLYN
    Provider Business Practice Location Address State Name: 
NY
    Provider Business Practice Location Address Postal Code: 
11208-3404
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
718-827-4000
    Provider Business Practice Location Address Fax Number: 
718-827-4001
    Provider Enumeration Date: 
01/14/2008