Provider First Line Business Practice Location Address:
401 DITMAS AVE
Provider Second Line Business Practice Location Address:
MEDICAL DENTAL PLAZA, FIRST FLOOR
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:
718-972-1644
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2013