Provider First Line Business Practice Location Address:
1729 EAST 12TH STREET, 2ND FLOOR
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:
11229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-375-2825
Provider Business Practice Location Address Fax Number:
718-375-4231
Provider Enumeration Date:
06/19/2009