Provider First Line Business Practice Location Address:
50 JAY STREET
Provider Second Line Business Practice Location Address:
PHOENIX HOUSE
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-222-6600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/02/2007