Provider First Line Business Practice Location Address:
1420 BUSHWICK 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:
11207-1422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-453-2277
Provider Business Practice Location Address Fax Number:
718-453-1489
Provider Enumeration Date:
01/19/2007