Provider First Line Business Practice Location Address:
225 LINCOLN PLACE,
Provider Second Line Business Practice Location Address:
APT #1F
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11217-3726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-399-7717
Provider Business Practice Location Address Fax Number:
718-300-7717
Provider Enumeration Date:
10/01/2009