Provider First Line Business Practice Location Address:
50 AVE X
Provider Second Line Business Practice Location Address:
ROOM 139, JOHN DEWEY HIGH SCHOOL
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-373-6400
Provider Business Practice Location Address Fax Number:
718-266-4385
Provider Enumeration Date:
03/28/2012