Provider First Line Business Practice Location Address:
247 BAY 22 STREET
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:
11214-6105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-372-2282
Provider Business Practice Location Address Fax Number:
718-449-5639
Provider Enumeration Date:
02/08/2008