Provider First Line Business Practice Location Address:
1729 E 12TH ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-1088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-998-7751
Provider Business Practice Location Address Fax Number:
718-645-1853
Provider Enumeration Date:
08/10/2005