Provider First Line Business Practice Location Address:
1560 E 56TH 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:
11234-4002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-765-4844
Provider Business Practice Location Address Fax Number:
516-565-0317
Provider Enumeration Date:
10/14/2005