Provider First Line Business Practice Location Address:
2525 HARING 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:
11235-1655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-769-3498
Provider Business Practice Location Address Fax Number:
718-648-7816
Provider Enumeration Date:
03/20/2012