Provider First Line Business Practice Location Address:
90 BRIGHTON 11TH ST
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:
11235-5304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-332-1423
Provider Business Practice Location Address Fax Number:
718-332-8933
Provider Enumeration Date:
07/26/2011