Provider First Line Business Practice Location Address:
1650 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:
11237-4002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-417-4565
Provider Business Practice Location Address Fax Number:
718-366-6302
Provider Enumeration Date:
01/12/2007