Provider First Line Business Practice Location Address:
1323 46TH ST
Provider Second Line Business Practice Location Address:
LEVEL-C (BASEMENT)
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11219-2165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-851-4770
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2011