Provider First Line Business Practice Location Address:
1441 E 12TH STREET
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:
11230-6605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-336-0861
Provider Business Practice Location Address Fax Number:
206-600-5513
Provider Enumeration Date:
07/03/2008