Provider First Line Business Practice Location Address:
1421 E 2ND 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:
11230-5501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-252-3365
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2007