Provider First Line Business Practice Location Address:
ONE BROOKDALE PLAZA, ROOM 169 CHC
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:
11212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-240-5615
Provider Business Practice Location Address Fax Number:
718-485-4064
Provider Enumeration Date:
08/23/2010