Provider First Line Business Practice Location Address:
1247 E 29TH ST
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:
11210-4630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-258-0362
Provider Business Practice Location Address Fax Number:
718-951-0285
Provider Enumeration Date:
12/26/2006