Provider First Line Business Practice Location Address:
577 PROSPECT AVE
Provider Second Line Business Practice Location Address:
BASEMENT SUITE
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11215-6065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-369-1444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2013