Provider First Line Business Practice Location Address:
831 56TH ST
Provider Second Line Business Practice Location Address:
BASEMENT FLOOR
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11220-3695
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-851-8881
Provider Business Practice Location Address Fax Number:
888-348-3657
Provider Enumeration Date:
01/04/2006