Provider First Line Business Practice Location Address:
1551 E 4TH ST
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:
11230-6318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-336-3343
Provider Business Practice Location Address Fax Number:
212-202-6025
Provider Enumeration Date:
04/11/2011