Provider First Line Business Practice Location Address:
1616A VOORHIES 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:
11235-3914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-616-1268
Provider Business Practice Location Address Fax Number:
718-616-1281
Provider Enumeration Date:
07/05/2005