Provider First Line Business Practice Location Address:
1424 HERKIMER STREET
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:
11233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-377-4231
Provider Business Practice Location Address Fax Number:
718-922-6486
Provider Enumeration Date:
10/30/2012