Provider First Line Business Practice Location Address:
1729 E 12TH ST
Provider Second Line Business Practice Location Address:
4TH FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-1088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-676-9866
Provider Business Practice Location Address Fax Number:
718-998-9059
Provider Enumeration Date:
02/13/2012