Provider First Line Business Practice Location Address:
2110 BATH AVENUE
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:
11214-4908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-265-5525
Provider Business Practice Location Address Fax Number:
718-265-1800
Provider Enumeration Date:
10/19/2005