Provider First Line Business Practice Location Address:
2053 E 16 ST.
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:
11229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-336-5005
Provider Business Practice Location Address Fax Number:
718-336-8679
Provider Enumeration Date:
09/05/2008