Provider First Line Business Practice Location Address:
965 48TH STREET
Provider Second Line Business Practice Location Address:
BROOKLYN
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-283-6021
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2006