Provider First Line Business Practice Location Address:
2245 E 19TH ST
Provider Second Line Business Practice Location Address:
APT 1 E
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-4662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-975-8145
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/05/2008