Provider First Line Business Practice Location Address:
1165 E 88TH ST
Provider Second Line Business Practice Location Address:
1165 EAST 88TH STREET
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11236-4762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-558-5020
Provider Business Practice Location Address Fax Number:
718-241-3733
Provider Enumeration Date:
12/28/2007