Provider First Line Business Practice Location Address:
163 LORIMER ST BSMT
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:
11206-2907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-765-5548
Provider Business Practice Location Address Fax Number:
917-924-5772
Provider Enumeration Date:
09/06/2012