Provider First Line Business Practice Location Address:
1455 E 24TH 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:
11210-5144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-376-7894
Provider Business Practice Location Address Fax Number:
718-645-3952
Provider Enumeration Date:
09/19/2005