Provider First Line Business Practice Location Address:
96 3RD AVE
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:
11217-2314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-625-0141
Provider Business Practice Location Address Fax Number:
718-222-0319
Provider Enumeration Date:
01/30/2010