Provider First Line Business Practice Location Address:
1421 CARROLL ST
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11213-4449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-842-4748
Provider Business Practice Location Address Fax Number:
718-616-1591
Provider Enumeration Date:
08/28/2008