Provider First Line Business Practice Location Address:
1738 E 34TH 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:
11234-4428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-339-4085
Provider Business Practice Location Address Fax Number:
718-339-2956
Provider Enumeration Date:
12/28/2010