Provider First Line Business Practice Location Address:
36 PLAZA ST E
Provider Second Line Business Practice Location Address:
SUITE #1A
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11238-5048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
347-617-6711
Provider Business Practice Location Address Fax Number:
347-586-0294
Provider Enumeration Date:
06/24/2005