Provider First Line Business Practice Location Address:
52 SEBA 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:
11229-6310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-332-9292
Provider Business Practice Location Address Fax Number:
718-332-5859
Provider Enumeration Date:
10/10/2005