Provider First Line Business Practice Location Address:
3120 BRIGHTON 5TH ST
Provider Second Line Business Practice Location Address:
SUITE 1C
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-7044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-934-1920
Provider Business Practice Location Address Fax Number:
718-934-2078
Provider Enumeration Date:
12/08/2014