Provider First Line Business Practice Location Address:
1122 AVENUE P
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:
11229-1025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-421-1212
Provider Business Practice Location Address Fax Number:
718-998-7660
Provider Enumeration Date:
05/22/2008