Provider First Line Business Practice Location Address:
2242 E 4TH 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:
11223-4823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-569-5458
Provider Business Practice Location Address Fax Number:
718-569-5459
Provider Enumeration Date:
05/07/2007