Provider First Line Business Practice Location Address:
253 36TH ST
Provider Second Line Business Practice Location Address:
SUITE 1-10
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11232-2546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-530-1450
Provider Business Practice Location Address Fax Number:
718-280-1333
Provider Enumeration Date:
07/17/2006