Provider First Line Business Practice Location Address:
1503 E 22ND 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:
11210-5122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-338-1736
Provider Business Practice Location Address Fax Number:
718-252-5666
Provider Enumeration Date:
11/28/2006