Provider First Line Business Practice Location Address:
1530 BEDFORD AVE
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:
11216-4117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-484-8818
Provider Business Practice Location Address Fax Number:
732-440-1483
Provider Enumeration Date:
05/17/2006