Provider First Line Business Practice Location Address:
1380 36TH 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:
11218-3045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-972-4820
Provider Business Practice Location Address Fax Number:
718-854-5383
Provider Enumeration Date:
06/13/2008