Provider First Line Business Practice Location Address:
621 AMBOY ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11212-4724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-345-2935
Provider Business Practice Location Address Fax Number:
718-345-2940
Provider Enumeration Date:
05/18/2007