Provider First Line Business Practice Location Address:
149 BRIGHTON 11TH 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:
11235-5357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-934-1128
Provider Business Practice Location Address Fax Number:
718-934-1102
Provider Enumeration Date:
07/09/2008