Provider First Line Business Practice Location Address:
145 HENRY ST APT 1G
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:
11201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-858-4924
Provider Business Practice Location Address Fax Number:
718-522-4954
Provider Enumeration Date:
05/14/2008