Provider First Line Business Practice Location Address:
856 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:
11221-1402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-707-6970
Provider Business Practice Location Address Fax Number:
718-707-6977
Provider Enumeration Date:
03/15/2013