Provider First Line Business Practice Location Address:
816 8TH AVENUE
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:
11215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-788-5762
Provider Business Practice Location Address Fax Number:
718-499-3753
Provider Enumeration Date:
07/17/2007