Provider First Line Business Practice Location Address:
242 HENRY ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11201-4608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-625-0537
Provider Business Practice Location Address Fax Number:
718-625-0612
Provider Enumeration Date:
09/05/2006