Provider First Line Business Practice Location Address:
1745 E 12 ST
Provider Second Line Business Practice Location Address:
APT 3 R
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-801-2151
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2008