Provider First Line Business Practice Location Address:
11 LYNCH 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:
11249-7892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-522-7877
Provider Business Practice Location Address Fax Number:
718-247-9786
Provider Enumeration Date:
03/02/2016