Provider First Line Business Practice Location Address:
1219 LIBERTY AVE
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:
11208-3411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-647-6057
Provider Business Practice Location Address Fax Number:
718-235-2813
Provider Enumeration Date:
10/16/2006