Provider First Line Business Practice Location Address:
420 MOTHER GASTON BLVD
Provider Second Line Business Practice Location Address:
C/O MED-RX PHARMACY
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11212-7618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-312-1048
Provider Business Practice Location Address Fax Number:
718-312-1049
Provider Enumeration Date:
03/31/2017