Provider First Line Business Practice Location Address:
1430 72ND ST
Provider Second Line Business Practice Location Address:
APT 3
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11228-1712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-232-4343
Provider Business Practice Location Address Fax Number:
718-232-4343
Provider Enumeration Date:
06/30/2010