Provider First Line Business Practice Location Address:
55 GREENE AVENUE
Provider Second Line Business Practice Location Address:
SUITE # 2F
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-783-3690
Provider Business Practice Location Address Fax Number:
718-783-5584
Provider Enumeration Date:
12/05/2006