Provider First Line Business Practice Location Address:
1562 UNION ST
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:
11213-4501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-344-9126
Provider Business Practice Location Address Fax Number:
718-778-4477
Provider Enumeration Date:
10/09/2013