Provider First Line Business Practice Location Address:
1215 47TH ST
Provider Second Line Business Practice Location Address:
SUITE #G2
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11219-2541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-853-0695
Provider Business Practice Location Address Fax Number:
718-853-7779
Provider Enumeration Date:
10/18/2010