Provider First Line Business Practice Location Address:
921 EAST NEW YORK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11203-1309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-778-8587
Provider Business Practice Location Address Fax Number:
718-735-8938
Provider Enumeration Date:
12/28/2006