Provider First Line Business Practice Location Address:
1114 E 32ND 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:
11210-4735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-974-1647
Provider Business Practice Location Address Fax Number:
718-252-5660
Provider Enumeration Date:
05/28/2014