Provider First Line Business Practice Location Address:
140 58TH ST BLDG B
Provider Second Line Business Practice Location Address:
SUITE 1 I
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11220-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-567-0255
Provider Business Practice Location Address Fax Number:
718-567-0288
Provider Enumeration Date:
05/10/2007