Provider First Line Business Practice Location Address:
2195 E 22ND ST
Provider Second Line Business Practice Location Address:
APT 1C
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11229-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-648-4545
Provider Business Practice Location Address Fax Number:
718-648-7788
Provider Enumeration Date:
08/15/2005