Provider First Line Business Practice Location Address:
401 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:
11218-4919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-480-6794
Provider Business Practice Location Address Fax Number:
718-480-6985
Provider Enumeration Date:
12/22/2011