Provider First Line Business Practice Location Address:
148 RUTLEDGE ST
Provider Second Line Business Practice Location Address:
BASEMENT
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11211-8005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-834-8430
Provider Business Practice Location Address Fax Number:
718-834-8021
Provider Enumeration Date:
06/26/2012