Provider First Line Business Practice Location Address:
567 9TH ST
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:
11215-4205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-840-0220
Provider Business Practice Location Address Fax Number:
718-965-2371
Provider Enumeration Date:
01/31/2013