Provider First Line Business Practice Location Address:
3071 BRIGHTON 13TH ST LOWR LEVEL
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:
11235-5607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-254-6292
Provider Business Practice Location Address Fax Number:
347-312-5811
Provider Enumeration Date:
10/18/2012