Provider First Line Business Practice Location Address:
425 HENRY ST
Provider Second Line Business Practice Location Address:
#104 NURSE
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11201-6010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-330-1217
Provider Business Practice Location Address Fax Number:
718-596-4989
Provider Enumeration Date:
03/27/2012