Provider First Line Business Practice Location Address:
1217 NEWKIRK AVE
Provider Second Line Business Practice Location Address:
APT 2
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11230-1505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-336-7763
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2016