Provider First Line Business Practice Location Address:
421 78TH STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11209-3447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-833-7535
Provider Business Practice Location Address Fax Number:
718-748-6487
Provider Enumeration Date:
11/29/2010