Provider First Line Business Practice Location Address:
1336 50TH 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:
11219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-435-6906
Provider Business Practice Location Address Fax Number:
718-435-6908
Provider Enumeration Date:
11/12/2013