Provider First Line Business Practice Location Address:
4711 CHURCH AVE
Provider Second Line Business Practice Location Address:
2ND FLOOR, DENTAL SUITE
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11203-3209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-485-4111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2017