Provider First Line Business Practice Location Address:
1614 W 5TH 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:
11223-1436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-339-8829
Provider Business Practice Location Address Fax Number:
718-339-5838
Provider Enumeration Date:
05/29/2007