Provider First Line Business Practice Location Address:
726 60TH STREET
Provider Second Line Business Practice Location Address:
LOWER LEVEL
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:
718-569-0106
Provider Business Practice Location Address Fax Number:
718-569-2190
Provider Enumeration Date:
07/19/2007