Provider First Line Business Practice Location Address:
1663 EAST 17 ST
Provider Second Line Business Practice Location Address:
BKLYN NY COMPREHENSIVE RESOURCES
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-600-3396
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2012