Provider First Line Business Practice Location Address:
1221 BEDFORD 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:
11216-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-919-1284
Provider Business Practice Location Address Fax Number:
718-919-1283
Provider Enumeration Date:
10/28/2010