Provider First Line Business Practice Location Address:
3048 BRIGHTON 1ST 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:
11235-8080
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-368-1170
Provider Business Practice Location Address Fax Number:
718-368-2342
Provider Enumeration Date:
07/31/2006