Provider First Line Business Practice Location Address:
1221 BEDFORD AVE
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:
11216-1801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-398-3499
Provider Business Practice Location Address Fax Number:
718-638-2813
Provider Enumeration Date:
07/21/2008