Provider First Line Business Practice Location Address:
2426 MERMAID AVE STE 1
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:
11224-2389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-676-2055
Provider Business Practice Location Address Fax Number:
718-676-2088
Provider Enumeration Date:
09/20/2006