Provider First Line Business Practice Location Address:
1723 E 12TH ST
Provider Second Line Business Practice Location Address:
SUITE 5L
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-1069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-336-1242
Provider Business Practice Location Address Fax Number:
718-336-1518
Provider Enumeration Date:
04/08/2008