Provider First Line Business Practice Location Address:
1559 E 13TH ST
Provider Second Line Business Practice Location Address:
FL 1
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11230-7105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-975-7338
Provider Business Practice Location Address Fax Number:
718-228-4488
Provider Enumeration Date:
09/14/2010