Provider First Line Business Practice Location Address:
2928 AVENUE P
Provider Second Line Business Practice Location Address:
1F
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-1896
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-375-9677
Provider Business Practice Location Address Fax Number:
718-596-7911
Provider Enumeration Date:
10/18/2005