Provider First Line Business Practice Location Address:
920 48TH 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:
11219-2918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-283-8138
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/28/2016