Provider First Line Business Practice Location Address:
120 LAWRENCE 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:
11201-3812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-277-0386
Provider Business Practice Location Address Fax Number:
845-765-9347
Provider Enumeration Date:
06/20/2013