Provider First Line Business Practice Location Address:
3047 BRIGHTON 6TH ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-6409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-743-7877
Provider Business Practice Location Address Fax Number:
718-743-4870
Provider Enumeration Date:
03/02/2010