Provider First Line Business Practice Location Address:
1402 NEWKIRK AVE
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:
11226-6522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-434-0931
Provider Business Practice Location Address Fax Number:
718-434-0932
Provider Enumeration Date:
07/14/2011