Provider First Line Business Practice Location Address:
2165 E 21ST 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:
11229-3607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-648-8130
Provider Business Practice Location Address Fax Number:
718-648-1094
Provider Enumeration Date:
12/16/2005