Provider First Line Business Practice Location Address:
1520 56TH ST
Provider Second Line Business Practice Location Address:
LOWER LEVEL
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11219-4737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-238-9554
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2011