Provider First Line Business Practice Location Address:
1036 LAFAYETTE AVE
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:
11221-3005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-574-4400
Provider Business Practice Location Address Fax Number:
347-425-7832
Provider Enumeration Date:
09/13/2010