Provider First Line Business Practice Location Address:
142 JORALEMON ST
Provider Second Line Business Practice Location Address:
SUITE 10A
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11201-4709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-488-0748
Provider Business Practice Location Address Fax Number:
810-815-6729
Provider Enumeration Date:
04/16/2007