Provider First Line Business Practice Location Address:
1447 56TH ST
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:
11219-4618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-436-4067
Provider Business Practice Location Address Fax Number:
718-331-9403
Provider Enumeration Date:
05/14/2009