Provider First Line Business Practice Location Address:
1610 E 19TH 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:
11229-1302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-576-6999
Provider Business Practice Location Address Fax Number:
718-576-6996
Provider Enumeration Date:
10/27/2011