Provider First Line Business Practice Location Address:
999 JAMAICA AVE
Provider Second Line Business Practice Location Address:
ROOM 167 SBHC
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-235-1087
Provider Business Practice Location Address Fax Number:
718-235-1291
Provider Enumeration Date:
04/24/2007