Provider First Line Business Practice Location Address:
164 20TH STREET SUITE 2E
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:
11232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-396-1742
Provider Business Practice Location Address Fax Number:
718-396-3297
Provider Enumeration Date:
02/16/2012