Provider First Line Business Practice Location Address:
249 19TH ST
Provider Second Line Business Practice Location Address:
4A
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11215-5480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-499-3054
Provider Business Practice Location Address Fax Number:
718-499-3089
Provider Enumeration Date:
10/23/2008