Provider First Line Business Practice Location Address:
650 FRANKLIN 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:
11238-3705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-623-9633
Provider Business Practice Location Address Fax Number:
718-623-9842
Provider Enumeration Date:
03/26/2010