Provider First Line Business Practice Location Address:
549 THROOP AVE
Provider Second Line Business Practice Location Address:
3F
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11216-2434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
947-884-4135
Provider Business Practice Location Address Fax Number:
718-576-9424
Provider Enumeration Date:
08/09/2006