Provider First Line Business Practice Location Address:
144 LEWIS AVE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11221-3674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-713-0009
Provider Business Practice Location Address Fax Number:
212-596-7188
Provider Enumeration Date:
11/22/2013