Provider First Line Business Practice Location Address:
567 1ST ST
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:
11215-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-777-1885
Provider Business Practice Location Address Fax Number:
718-777-9613
Provider Enumeration Date:
08/12/2005