Provider First Line Business Practice Location Address:
1540 48TH 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:
11219-3249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-716-0438
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/25/2014