Provider First Line Business Practice Location Address:
374 STOCKHOLM ST
Provider Second Line Business Practice Location Address:
C/O FACULTY PRACTICE MANAGEMENT- SUITE I37 NORTH
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11237-4006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-963-6734
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/09/2008