Provider First Line Business Practice Location Address:
150 55TH STREET
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:
11220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-270-1603
Provider Business Practice Location Address Fax Number:
718-270-2667
Provider Enumeration Date:
12/22/2005