Provider First Line Business Practice Location Address:
418 LAFAYETTE AVENUE
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:
11238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-545-9725
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/05/2014