Provider First Line Business Practice Location Address:
1414 NEWKIRK 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:
11226-6522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-338-6868
Provider Business Practice Location Address Fax Number:
718-252-3650
Provider Enumeration Date:
08/19/2008