Provider First Line Business Practice Location Address:
824 55TH STREET (BET. 8TH & 9TH AVE.)
Provider Second Line Business Practice Location Address:
BROOKLYN
Provider Business Practice Location Address City Name:
NY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-686-1733
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2013