Provider First Line Business Practice Location Address:
36 HERKIMER ST
Provider Second Line Business Practice Location Address:
APT 1
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11216-2797
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-249-6919
Provider Business Practice Location Address Fax Number:
718-378-2314
Provider Enumeration Date:
05/22/2013