Provider First Line Business Practice Location Address:
1829 E 13TH ST
Provider Second Line Business Practice Location Address:
UNIT 1A
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-2886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
551-486-0281
Provider Business Practice Location Address Fax Number:
201-567-3208
Provider Enumeration Date:
10/23/2008