Provider First Line Business Practice Location Address:
195 BEDFORD AVE.
Provider Second Line Business Practice Location Address:
UNIT 1
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11211-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-384-6281
Provider Business Practice Location Address Fax Number:
212-937-3540
Provider Enumeration Date:
10/29/2007