Provider First Line Business Practice Location Address:
1320 52ND 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:
11219-3802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-435-0220
Provider Business Practice Location Address Fax Number:
718-854-8764
Provider Enumeration Date:
07/14/2006