Provider First Line Business Practice Location Address:
1316 48TH 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:
11219-3167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-436-8988
Provider Business Practice Location Address Fax Number:
718-435-8861
Provider Enumeration Date:
08/27/2008