Provider First Line Business Practice Location Address:
150 ALBANY AVE
Provider Second Line Business Practice Location Address:
PAUL ROBESON 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:
11213-5716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-774-0300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2012