Provider First Line Business Practice Location Address:
1315 AVENUE J
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:
11230-3605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-253-1030
Provider Business Practice Location Address Fax Number:
718-676-2665
Provider Enumeration Date:
10/14/2010