Provider First Line Business Practice Location Address:
228 METROPOLITAN AVE
Provider Second Line Business Practice Location Address:
APT 14
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11211-4060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-698-9102
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2016