Provider First Line Business Practice Location Address:
116 79TH 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:
11209-3508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-745-4141
Provider Business Practice Location Address Fax Number:
718-680-0791
Provider Enumeration Date:
07/09/2010