Provider First Line Business Practice Location Address:
2060 E 19TH ST FRNT OFFICE
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:
11229-3943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-278-6081
Provider Business Practice Location Address Fax Number:
718-336-3829
Provider Enumeration Date:
12/31/2007