Provider First Line Business Practice Location Address:
3062 BRIGHTON 3RD 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:
11235-7409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-769-0090
Provider Business Practice Location Address Fax Number:
718-743-9680
Provider Enumeration Date:
07/30/2006