Provider First Line Business Practice Location Address:
512 CENTRAL 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:
11221-5231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-306-2714
Provider Business Practice Location Address Fax Number:
718-366-4030
Provider Enumeration Date:
11/04/2011