Provider First Line Business Practice Location Address:
1220 E NEW YORK AVE
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:
11212-3832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-417-9733
Provider Business Practice Location Address Fax Number:
347-627-6800
Provider Enumeration Date:
10/23/2013