Provider First Line Business Practice Location Address:
743 WASHINGTON AVE
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:
11238-4503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-638-6002
Provider Business Practice Location Address Fax Number:
718-638-7085
Provider Enumeration Date:
11/28/2006