Provider First Line Business Practice Location Address:
1870 EAST 19 STREET
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:
11598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-232-7877
Provider Business Practice Location Address Fax Number:
718-232-4031
Provider Enumeration Date:
11/27/2006