Provider First Line Business Practice Location Address:
1318 42ND 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:
11219-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-436-2496
Provider Business Practice Location Address Fax Number:
718-972-5404
Provider Enumeration Date:
09/16/2005