Provider First Line Business Practice Location Address:
2407 EAST 23RD STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-648-2400
Provider Business Practice Location Address Fax Number:
718-648-3100
Provider Enumeration Date:
12/18/2014