Provider First Line Business Practice Location Address:
2626 EAST 14TH ST.
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-3966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-282-3311
Provider Business Practice Location Address Fax Number:
718-517-2523
Provider Enumeration Date:
12/28/2011