Provider First Line Business Practice Location Address:
948 48TH 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:
11219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-283-8260
Provider Business Practice Location Address Fax Number:
718-283-6147
Provider Enumeration Date:
07/28/2006