Provider First Line Business Practice Location Address:
1319 EAST 17 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-336-1515
Provider Business Practice Location Address Fax Number:
718-336-0585
Provider Enumeration Date:
03/23/2010