Provider First Line Business Practice Location Address:
1819 E 13TH ST
Provider Second Line Business Practice Location Address:
BASEMENT
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-2870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-342-3384
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2008