Provider First Line Business Practice Location Address:
1762 E 23RD 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:
11229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-382-0012
Provider Business Practice Location Address Fax Number:
718-382-0158
Provider Enumeration Date:
07/26/2005