Provider First Line Business Practice Location Address:
1453 EAST 12 STREET
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:
11230-6605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-753-4184
Provider Business Practice Location Address Fax Number:
718-252-2472
Provider Enumeration Date:
03/11/2009