Provider First Line Business Practice Location Address:
1611 E NEW YORK AVE
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:
11212-6860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-331-0522
Provider Business Practice Location Address Fax Number:
347-331-0544
Provider Enumeration Date:
11/07/2006