Provider First Line Business Practice Location Address:
1671 NEW YORK 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:
11210-3366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-434-5345
Provider Business Practice Location Address Fax Number:
718-434-5567
Provider Enumeration Date:
08/08/2007