Provider First Line Business Practice Location Address:
2761 BATH AVE
Provider Second Line Business Practice Location Address:
BASEMENT
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11214-5551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-676-7770
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/19/2009