Provider First Line Business Practice Location Address:
1887 NOSTRAND 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:
11226-7917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-282-2927
Provider Business Practice Location Address Fax Number:
718-284-2284
Provider Enumeration Date:
06/15/2005