Provider First Line Business Practice Location Address:
1140 40TH ST
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11218-1935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-436-0440
Provider Business Practice Location Address Fax Number:
718-853-5575
Provider Enumeration Date:
12/19/2005