Provider First Line Business Practice Location Address:
1520 50TH ST
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:
11219-3745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-871-6663
Provider Business Practice Location Address Fax Number:
718-431-2452
Provider Enumeration Date:
01/22/2015