Provider First Line Business Practice Location Address:
2275 COLEMAN STREET,
Provider Second Line Business Practice Location Address:
SUIT 4/LOWER PARKING LOT LEVEL
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-615-0049
Provider Business Practice Location Address Fax Number:
866-845-3415
Provider Enumeration Date:
01/22/2014