Provider First Line Business Practice Location Address:
904 49TH ST
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11219-2922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-283-7741
Provider Business Practice Location Address Fax Number:
718-635-7424
Provider Enumeration Date:
10/18/2005