Provider First Line Business Practice Location Address:
1383 BUSHWICK 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:
11207-1407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-455-5065
Provider Business Practice Location Address Fax Number:
718-455-9398
Provider Enumeration Date:
05/07/2007