Provider First Line Business Practice Location Address:
1953 E 22ND 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:
11229-3615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-375-1490
Provider Business Practice Location Address Fax Number:
718-375-1490
Provider Enumeration Date:
10/19/2011