Provider First Line Business Practice Location Address:
149 WASHINGTON AVE
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:
11205-2512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
917-204-0123
Provider Business Practice Location Address Fax Number:
718-622-8892
Provider Enumeration Date:
06/28/2012