Provider First Line Business Practice Location Address:
140 58TH ST STE A
Provider Second Line Business Practice Location Address:
UNIT 3L
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11220-2539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-934-1918
Provider Business Practice Location Address Fax Number:
718-934-2003
Provider Enumeration Date:
07/12/2013