Provider First Line Business Practice Location Address:
2380 EAST 22 STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-847-2660
Provider Business Practice Location Address Fax Number:
631-297-1333
Provider Enumeration Date:
01/17/2013