Provider First Line Business Practice Location Address:
128 DITMAS 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:
11218-4902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-431-8232
Provider Business Practice Location Address Fax Number:
718-431-8253
Provider Enumeration Date:
02/09/2007