Provider First Line Business Practice Location Address:
1208 AVENUE Z
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:
11235-4302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-368-2699
Provider Business Practice Location Address Fax Number:
718-368-2544
Provider Enumeration Date:
01/03/2007