Provider First Line Business Practice Location Address:
717 HALSEY ST
Provider Second Line Business Practice Location Address:
LOWR LEVEL
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11233-1206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-589-0016
Provider Business Practice Location Address Fax Number:
516-977-3266
Provider Enumeration Date:
11/21/2006