Provider First Line Business Practice Location Address:
3310 NOSTRAND AVE
Provider Second Line Business Practice Location Address:
ROOM L-3
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-3756
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-375-9257
Provider Business Practice Location Address Fax Number:
718-375-9259
Provider Enumeration Date:
03/28/2008