Provider First Line Business Practice Location Address:
589 METROPOLITAN 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:
11211-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-963-2383
Provider Business Practice Location Address Fax Number:
718-963-3780
Provider Enumeration Date:
09/12/2005