Provider First Line Business Practice Location Address:
1394 SCHENECTADY 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:
11203-6532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-801-7486
Provider Business Practice Location Address Fax Number:
718-282-4639
Provider Enumeration Date:
12/29/2008