Provider First Line Business Practice Location Address:
602 FLATBUSH 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:
11225-4910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-287-2882
Provider Business Practice Location Address Fax Number:
718-287-8564
Provider Enumeration Date:
12/13/2005