Provider First Line Business Practice Location Address:
10001 FLATLANDS AVE
Provider Second Line Business Practice Location Address:
MEDICAL OFFICE-ROOM 319
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11236-2615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-927-5228
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2012