Provider First Line Business Practice Location Address:
1502 E 14TH STREET
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-541-6241
Provider Business Practice Location Address Fax Number:
718-764-1229
Provider Enumeration Date:
01/03/2011