Provider First Line Business Practice Location Address:
145 LINCOLN RD
Provider Second Line Business Practice Location Address:
APT. 6B
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11225-4079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-287-7962
Provider Business Practice Location Address Fax Number:
718-287-7962
Provider Enumeration Date:
01/18/2015