Provider First Line Business Practice Location Address:
1315-53RD STREET
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:
11219-3823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-436-0202
Provider Business Practice Location Address Fax Number:
718-436-8019
Provider Enumeration Date:
10/24/2006