Provider First Line Business Practice Location Address:
1020 E 48TH ST
Provider Second Line Business Practice Location Address:
2ND FLR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11203-6600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-693-1999
Provider Business Practice Location Address Fax Number:
718-693-1977
Provider Enumeration Date:
11/20/2006