Provider First Line Business Practice Location Address:
1900 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:
11229-1527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-340-1439
Provider Business Practice Location Address Fax Number:
718-382-9010
Provider Enumeration Date:
09/27/2006